258493 (BLCK)BUILDING PERMIT
CONSTRUCTION ESTIMATE
1 ST FL. SO.FT. @
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SOFT. @
WALL SQ. FT. @
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used as property tax valuation
MECHANICAL FEES
VFNT SYSTEM Fl FAN n FVAP. COOL ❑ HOOD
DEPARTMENT OF BUILDING & SAFE
COUNTY OF RIVERSIDE
NO. ELECTRICAL FEES
UNITS 1
MOBILEHOME SVC.
POWER OUTLET
SWIM POOL, PVT
SWIM POOL. COMM
SIGN
FIELD OFFICE
NO.I PLUMBING FEES
BOILER I I B.T.U.
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
WASHER (AUTO) (DISH)
APPLIANCE GARBAGE DISPOSAL
FURNACE 0 UNIT 0 WALL 0 FLOOR 0 SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM IDLE METER KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U. TEMP USE PERM SVC WATER CLOSET
COMPRESSOR 0 HP POLE, TEMP/PERM LAVATORY
HEATING SYSTEM 0 FORCED O GRAVITY AMPERES SERV ENT SHOWER
SQ FT @ a BATH TUB
SOFT @ a WATER HEATER
SQ FT RESID @ la SEWAGE DISPOSAL
SQ FT GARAGE @ '/za HOUSESEWER
PERMIT FEE TEMP ELEC SVC GAS PIPING
MOBILE HOME PERMIT FEE is
PERMIT FEE PERMIT FEE
PERMIT NO.
2584931
TLE Ei
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MOB. HM. FEE
MICRO FEE
MECH. FEE
DBL.
PL. CK. FEE
CON+ST. FF
DBL.
ELECT. FEE
DBL.
SMI FEE
FEE PLUMB. FEE
J
DBL.
J I F I M A I M I J I i A I S 1 O 1 N D
10 ADDRESE,t ' SP NO
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73
74
7.5
USE 0,F PERMIT Je
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F.C.
DATE
�T 7
P T 0 {/
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9
M H PERMIT FEE
$
COMMUNITye
AJ 7-04 -
DST
UNITS I
ROOMS
VALUATION
SUPP. TO PERMIT
air C�
OFF CE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION �y
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MECHANICAL FEE
DBL
$
SETBACK
LOT SIZE ZONE
"'El
USE NO.
GRP
TYPE
CK BY
F S R
PLAN CHECK FEE
$
BOND AMT.
PLAN N0.
PLAN CHECKER
FINAL DAT /(r,ne 1i INSPE
3— r,C 1/
h!kl
OR
CONSTRUCTION FEE
DBL
$�+�
A
NAME OF CONST. LENDER BRANCH
OFFICE
NO LENDER INVOLV '
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
SMI FEE
$
THIS PERMIT SHALL BECOME VOID 1F WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSA-
TION 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 AC-
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO
.AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITH THE
LAWS OF THE STATE OF.CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREP 4ED THE PLANS AND SPECIFICATIONS
HAS DONE SO IN ACCORDANCE WITH SECTION 5541 HE BUSND PROFESSIONS CODE
OF THE STATE OF CALIFORNIA.}
FEE
$
PLUMBING FEE
DBL
$
TOTAL FEES 0
;;5—�--
OWNER/AGENT'S SIGNATURE
CONTRACTOR �.✓•
e2�
,C*1i Hca
CASH ❑ CHECK M.O. ❑ N.C. ❑
ADDRESS
ADDRESS f
RECEIVED BY f
TREES REQUIRED
t
..SEWAGE SYSTEM
T
LL P
CITY ZIP CODE
CITY ZIP CODE.
INFORMATION �j
FORD 284206 )Rev. 9.731 Os (,�L�.?f.(,�
TEL. NO.
TEL. NO. LICENSE
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