179330 (AR)DEPARTMENT OF BUILDING & SAFETY
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
•
COUNTY OF RIVERSIDE
.
FIELD OFFICE''
APPLIANCE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
Par.
Car.
Car P.
Wall
Sq. Ft. 44 9.
!Xl
NO.
F
DATE
NO.
Sq. Ft. @
Sq. Ft. @
Sq. Ft. @ PDL s
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
Sq. Ft. @ SIGNS
DRAINAGE PIPING
Sq. Ft. @ TRANS. AND/
OR T. CLK.
DRINKING FOUNTAIN
Sq. Ft. @ MOTOR H. P.
URINAL
MOTOR H. P.
WATER PIPING
ESTIMATED VALUATION $
�, MOTOR
H. P.
FLOOR DRAIN ±
MECHANICAL FEE $r
MECHANICAL FEES
MOTOR
H. P.
WATER'SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
SET BACK
MOTOR H. P.
LOT SIZE
-
WASHER (AUTO) (DISH)
APPLIANCE
F
FIXTURES
R
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
ZONE
OUTLETS
DATE
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
..
WATER CLOSET
COMPRESSOR E::�HP
CH CK D BY
RANGE AND/OR OVEN
ISTRI CT
LAVATORY
APPLIANCE VENT
49
WATER HEATER
MECHANICAL FEE $r
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
I
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
IF-
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
LEGAL DESCRIPTION
SERVICE ENTRANCE
PERMIT
SEWAGE DISPOSAL
BOILER B.T.U.
RESID. 1Q SO. FT.
^4's
HOUSE SEWER
PERMIT FEE
GARAGE iQ SQ. FT.
GAS PIPING
CONSTRUCTION FEE $
_.,-
PERMIT FEE
'^J',
PERMIT FEE
JR T U e REN. DBL. TOTAL FEES' HEAT & VENT FEE PLN. CK. s CONST. FEE ELEC. FEE �0 PLUMB. FEE d
J
J
J C M A M J J A 5 D N D
SET BACK
LOT SIZE
-
USE #
•
JOB ADDRESS OWNER �i-/y /.��,.y� �j
A LIE � / /l� iell/Y
F
S .r
R
ZONE
USE OF BUILDING
DATE
JC_
�.M"
67./3.�
PLAN CHECK FEE $
..
'
CH CK D BY
COMMUNITY
ISTRI CT
F.C.
UNITS111A�LUATION
49
OF FI E
MECHANICAL FEE $r
I
If,?
IF-
R P
TYPE
LEGAL DESCRIPTION
PERMIT
NUMBER
CONSTRUCTION FEE $
_.,-
v � �. -
179330
SPEC. INSP.
SUPP. TO PERMIT
.. av
ELECTRICAL FEE $
ter'
PLAN CHECKER
BOND $
BOND
CASH
PLAN FILE #
FINAL DATE
INSPECTOR
PLUMBING FEE $
6'd/' 70
TOTAL FEES
6
THIS EDAYSRMIT VOID I R 1 COMMENCEDS NOT
OOF
';�'
.SCES AT ONHALL
WITHIN 60WORK FOR 0DAYS 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. 1 ALSO AGREE TO
Y
LL
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
TRACTORS IS ALSO GUARANTEED.
✓
NAME OF CONSTRUCTION
LENDER
OWNER
CONTRACTOR
BRANCH OFFICE
[ '
ADDRESS
ADDRESS
ADDRESS
CITY
STATE
NO LENDER INVOLVED
INFORMATION
TEL. NO.
TEL. NO.
LICENSE NO.
84-208 12/88 `,� -
- LLYY�-