184271 (PAT)e �
DEPARTMENT OF BUILDING &q SAFETY
VENT SYSTEM ❑ FAN ❑ EVAP. COOL
0
COUNTY_ OF RIVERSIDE
.
FIELD OFFICE
APPLIANCE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
Por.
Gar.
Car P.
Wall
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑
Sq. Ft. @
NO.
�.%
NO.
Sq. Ft. @
CN `CNED BY
Sq. Ft. @� tlG> �(ta
Sq. Ft. @ POLES
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑
Sq. Ft. @ SIGNS
DRAINAGE PIPING
TRANS. AND/
Sq. Ft. @ OR T. CLK.
DRINKING FOUNTAIN
Sq. Ft. @ MOTOR H. P.
URINAL
MOTOR H. P.
WATER PIPING
ESTIMATED VALUATION $ �t "F�"
.y,,��
S+� MOTOR
H. P.
FLOOR GRAIN
,ry
�s
MECHANICAL FEES
ABSORPTION SYSTEM
D B.T.U.
VENT SYSTEM ❑ FAN ❑ EVAP. COOL
❑ HOOD
MOTOR
H. P.
WASHER (AUTO) (DISH)
APPLIANCE
F .. S R
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑FLOOR ❑
SUSPENDED
OUTLETS
�.%
LAUNDRY TRAY
AIR HANDLING UNIT
CN `CNED BY
SUB -PANEL
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑
OIL
WATER CLOSET
COMPRESSOR �HP
RANGE AND/OR
OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
,ry
�s
SHOWER
ABSORPTION SYSTEM
D B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS.
❑ COMM.
CONSTRUCTION
POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANCE
SEWAGE DISPOSAL
BOILER B.T.U.
RESID. 1C 50.
FT.
MOUSE SEWER
PERMIT FEE
A/ FILE
GARAGE zQ 50.
FT.
GAS PIPING
PERMIT FEE
PERMIT FEE '
PERMIT NUMBER REN. DBL. TOTAL FEES IHEAT & VENT FEE IPLN, CK, FEE ICON. FEE I
ELEC. FEE PLUM B. FEE
44 � �
.FM.� -A ��-MJ J. _ A .5 N
SET BACK LOT SIZE
USE 4
JOB ADDRESS OWNER
F .. S R
ZONE
f)OF U L NG _ b TE
PLAN CHECK FEE $
�.%
'?T"d 14-2
26
CN `CNED BY
COMMUNI V D ICT
U TSIVALUAT
ION OFFICE
MECHANICAL FEE $+
Cf�OUP
PE
LEGAL DE CRIPT iON
RMIT NUMBER
,ry
�s
'/
CONSTRUCTION FEE $
♦ .� ~ _
84271
ELECTRICAL FEE $'-1
SPEC. IN5P.
"
SUPP. TO PERMIT
PLAN CHECKER
BOND $
ON
CASH
A/ FILE
FINAL DATE
INSPECTOR -
PLUMBING FEE $
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
'nee,__
T
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
r+f
ADDRESS
ADDRESS
ADDRESS' �
CITY STATE
I6/•
NO LENDER INVOLVED/C'
INFORMATION
TEL. NO.
TEL. NO.
LICENSE EN 9E NO.
:84-208 12/68-/
/