166911 (RPL)DEPARTMENT OF BUILDING & SAFETY
Ank COUNTY OF RIVERSIDE Aak FIELD OFFICE
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1st FI. Sq. Ft. @
2nd FI. Sq. Ft. @
Par. Sq. Ft. @
Gar. Sq. Ft. @
Car P. Sq. Ft. @ .
al1� 7 Sq. Ft. @
# Sq. Ft. @
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I ESTIMATED VALUATION Is
MECHANICAL FEES `
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
APPLIANCE
} FURNACE UNIT❑ WALL❑ FLOOR SUSPENDED
J
I Z AIR HANDLING UNIT
F 0
( J GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
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U COMPRESSOR �HP
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m APPLIANCE VENT
F
f
i f ABSORPTION SYSTEM D B.T.U.
0
U INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
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HEATING SYSTEM ❑ FORCED ❑ GRAVITY
f BOILER B.T.U.
RESIDENTAL FEE SQ.FT.E:::��0
L' PERMIT FEE
ELECTRICAL
FEES
PLUMBING FEES
NO.
REN. DBL.ITOTAL
NO.
FEES
HEAT & VENT
PLN. CK. FEE
CONST. 'FEE
ELEC. FEE
PLUMB, FEE
POLES
SIGNS
DRAINAGE PIPING .
TDRINKING
OR TCLK,
FOUNTAIN
`
MOTOR
H.P.
URINAL,
MOTOR
H. P.
WATER PIPING
MOTOR
H. P.
FLOOR GRAIN
jo
MOTOR
M.P.
WATER SOFTENER �7)
MOTOR
M.P.
WASHER (AUTO) (DISH)
FIXTURES
R
GARBAGE DISPOSAL '
OUTLETS
LAUNDRY TRAY
SUB-PAMEL
ZONE
KITCHEN SINK
[(F? PLAN CHECK FEE -ti ,0
WATER CLOSET
RANGE AND/OR OVEN
LAVATORY
WATER HEATER
COM NI Y bN 4 / I 1 DI RI
SHOWER
SPACE HEATER
VALUATION
BATH TUB
CONSTRUCTION POLE
WATER HEATER
SERVICE ENTRANCE
SEWAGE DISPOSAL
RESID. It SQ. FT.
MECHANICAL FEE
WE a (J
GARAGE f C SQ. FT.
GAS PIPING
! PERMIT FEE
A
f I court cam..- . 1'
PERMIT NU
E
1
REN. DBL.ITOTAL
FEES
HEAT & VENT
PLN. CK. FEE
CONST. 'FEE
ELEC. FEE
PLUMB, FEE
r•'
J F M A M J - J A S
J F M q M J J A S
O N D
O N D
I
SET BACK
LOT SIZE
USE #
JOB ADDRESS
OWNER
P
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I 5
R
y
ZONE
SOF BCTII ING % 'DAT
[(F? PLAN CHECK FEE -ti ,0
,
k
f
C EC ED BY
COM NI Y bN 4 / I 1 DI RI
F.0
UNITS
VALUATION
OFTic C
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!
MECHANICAL FEE
s
CONSTRUCTION FEE
TYPE
LEGAL ESCRIPTION -
t
"'d^41 p.-
-16
PERMIT HUM El
6 Q 1
•
ELECTRICAL FEES
SPEC. INSP.
SUPP. TO PERMIT
PLAN CHECKER
BOND $
BOND CASH
PLAN FILE #
FINAL
INSPECTOR
PLUMBING FEE 4-A�Jc
I
`{DATE
j
1 l
TOTAL FEES
$�
THIS
PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED'
WITHIN 60 DAYS. CESSATION OF WORK FOR 120 DAYS SHALL ALSO
CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
CASH CHECK M.O. N.C.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
F;
T
LL
P
CARRY COMPENSATION INSURANCE UPON LMPLOYIEES. COMPLI-
ANCE WITH LAWS OF THE STATE .OR",'C%1LIF 1" OVERING CON -
TRACTORS IS ALSO GUARANTEED
INFORMATION
P2 F C�r�tSTWUCTI;�:rUSMRS
for
OWNER VCn'.Ti
"T A•
I'
pf
ICH OFFM
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ls i�l�
AdDR - S' ' -
A D ES
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*0 L.131 D&H INVOLVED
'
TEL. NO. r /„
-EL. NO.
L�CtN SEN O.
l
!284-208 11/87
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