219631 (AR)BUILDING PERMIT
SIGN
DEPARTMENT OF BUILDING & SAFET
COUNTY OF RIVERSIDE
APPLIANCE
FIELD OFFICE
GARBAGE DISPOSAL
CONSTRUCTION ESTIMJE
OUTLETS
ELECTRICAL FEES
AIR HANDLING UNITI CFM
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
GAS PIPE ❑ NATURAL .❑ L.P.G. ❑ OIL
SQ. FT.
WATER CLOSET
NO.
POLE
NO.
SQ. FT. @
AMPERES SERV. ENT.
SQ. FT. @ MOTOR 1 OR LESS H.P.
ABSORPTION SYSTEM B.T.U.
SQ. FT. @ MOTOR 5 OR LESS H.P.
BATH TUB
SQ. FT. @ MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
OK.W.UNITS
WATER PIPING
ESTIMATED VALUATION $
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
FLOOR DRAIN
MECHANICAL FEES
PLAN CHECK FEE
$�
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP.COOL❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER [=K•W
GARBAGE DISPOSAL
FURNACE❑UNIT❑WALL❑FLOOR ❑SUSPENDED'
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNITI CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE ❑ NATURAL .❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR 0 HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM B.T.U.
SQ. FT. @ R
BATH TUB
INCINERATOR ❑ DOMESTIC E] INDUS. OR COMM.
SQ. FT.@ 4:
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 Q
SEWAGE DISPOSAL
BOILER O B.T.U.
SQ, FT. GARAGE @ z ¢
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE
$' PERMIT FEE
1,,l
p V I
I PERMIT FEE
PERMIT NUMBER
TOL �jPF�
MOB. HOOK FEE
HEAT 6 VENT FEE
DBl PK
N9
631
DBL
E�C. FFy6
DBL
COMMUNITTY-.�
PLUMBING FEE
DBL0,6010
OOMJ
VALUATION
7 6
SUPP. TO PERMIT
OFFICE
MOBILEHOME
HOOKUP FEE
$
J
JPNST.�Eb
J
DBL
$0
��
SET BACK
J
J F M A M J J A S O
72
N D
JOB ADDRESS- ,y/�• y/
OWNER tt
73
74
USE OF BUILDING
w
F.C.
DATE
7,
PE 1T
1
N9
631
75
76
COMMUNITTY-.�
DST
Ir
I UNITS
OOMJ
VALUATION
7 6
SUPP. TO PERMIT
OFFICE
MOBILEHOME
HOOKUP FEE
$
e + LEGA,�LL. DESCRIPTION
v?h_a 6/ I H;a Gakf�S
"
MECHANICAL- FEE
DBL
$0
SET BACK
LOT SIZE
1-/7j;-
ZONE
I USE NO.
GRP
TYPE lCKBY
s R C3
PLAN CHECK FEE
$�
O
BOND AMT.
I PLAN NO.
PLAN CHECKERFINAL
DATE JIN
,/ r 3
PECTOR
CONSTRUCTION FEE
DBL
,�/�/
6 0
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVED
/
ELECTRICAL FEE
DBL
$
ADDRESS_
CITY STATE
FEE
$
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 PERMIT WILL BE DONE
IN .ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF -
ORNIA. FALSO AGREE'TO CARRY COMPENSATION- INSURANCE UPON MY EMPLOYEES.
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
PLUMBING FEE
DBL
IS ALSO GUARANTEED. -
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFI-
CATIONS HAS DONE, SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND
PROFESSIONS CODE OF THE STATE -OF CALIFOFWIA.
TOTAL FEES $��
CASH ❑ CHECK tal- M.O. ❑ N.C. ❑
OWNER C T
'17_ 4c ..P. p
Received By
ADDRESS ADDRESS
Sewage System T
LL.
P •
CITY CITY ,
Trees Required
Yes
NO
mrvnlwralluN
FORM 284-208 (REV. 4/7101
T
ICEN5E
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