222939 (SATT)BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY : " ` FIIELD:OFFIGE
• COUNTY OF RIVERSIDE •
CONSTRUCTION ESTIMATE.Y,-.;- c ELECTRICAL FEES,_.,n,w„,. -._ 'PLUMBING FEES
I ST FL.SQ. FT. Cia NO NO.�
2ND FL. SQ. FT. Cia
POR. SQ. FT. . Cai MOTOR I OR LESS H.P.
.GAR. SQ.FT.
MOTOR 5 OR LESS H.P.
CAR P. SQ. FT. @MOTOR 20 OR LESS H.P. r DRAINAGE PIPING
WALL SQ.FT. Cai^ DRINKING FOUNTAIN
SQ. FT.n URINAL
ESTIMATED CONSTRUCTION VALUATION$ O K W. UNITS WATER PIPING
NOTE:'Not to be used as property tax Laluotion I FLOOR DRAIN
MFGHANICAL FEES WATER SOFTENER'
MOBILE HOME HOOKUP FEE- I$ . I 1 1 1 I PERMn FEE I ,Y I t3t91 i ..I PERMIT FEE I -121 60'.
s
PE IT NO. *
VENT SYSTEP jFAN ❑EVAP. COOL [.$HOOD
SIGN
WASHER (AUTO) (Q")
- MECH. FEE-
APPLIANCE
TRANS-. K W.
FORMER
GARBAGE DISPOSAL --
DBL: ELECT. F� DBL.
FURNACE ❑UNIT ❑WALL ❑FLOORSUSPENDED ,
OUTLETS•
LAUNDRY TRAY
"
AIR HANDLING UNIT I CFM
FIXTURE OR SOCKET
KITCHEN SINK
.._
GAS PIPE ❑ NATURAL ❑ L.P.G. OOIL
CONST. SERV. ENTRANCE
WATER CLOSET
`'
COMPRESSOR HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT. V43
SHOWER
ABSORPTION SYSTEM B.T.U.
SO. FT. @ Q
BATH TUB,"
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT. @ . Q
WATER HEATER 1 "`
t _
HEATING SYSTEM ORCED ❑ GRAVITY
4040 SQ. FT. RESID. @ 1
SEWAGE DISPOSAL -
_
BOILER 0 B.T.U.
SQ. FT. GARAGE @lbj
HOUSE SEWER
o,`N,r+a�. .....= r.. .> .. _
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING '
MOBILE HOME HOOKUP FEE- I$ . I 1 1 1 I PERMn FEE I ,Y I t3t91 i ..I PERMIT FEE I -121 60'.
s
PE IT NO. *
NOTAL FEES
MOB. HK. FEE MICRO FEE
- MECH. FEE-
DBL.
PL. CK `FEE
CONST. FEE
DBL: ELECT. F� DBL.
SMI FEE
FEE PLUMB. FEE
229
`'
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M- ,J _J_ N- -D-
lOB•ADDRESS - - . - �•� �....�-^� �..
o,`N,r+a�. .....= r.. .> .. _
73
74 -
BUILDING
P ER N
2939
75
a.:-
M.H. HOOKUP FEE`
$
Co UNITY
D UNITS
ROOMS
VAL AT%ON SUPP. TO PERMIT
OFFICE
-
MICROFILM FEE--
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL$
•'
SET BACK LOT SIZE - - -
ZONE a USE NO.
GRP
TYPE
CK BY
F 15 IR
PLAN CHECK FEE
$ONAM
T. PLAN NO. PLAN CHECKER
I A TE. V INSPECTOR
Ute"'
.
�,we
S!
a.1 '�
liz.
CONSTRUCTION FEE;'_
_
DBL
$
NAME OF CONST. LENDER BRANCH
OFFICE - - J.NO
LENDER INVOLVED
i
ELECTRICAL FEE _ _
DBL
$ .
s
ADDRESS -- CITY
.- STATE
,
V•
�•
SMI FEE
$
K�
THIS,PERMIT-SHALL-BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS. CESSA-
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE FERMI C TO BECOME VOID.
FEE
$ '
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
PLUMBING FEE
DBL
$
AGREE TO CARRY 'COMPENSATION INSURANCE UPON MY 'EMPLOYEES. COMPLIANCE WITH'
>
THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.
1 HEREBY CE51�6FY-VAT THE INDIVIDUAL• -WHO` PREPARED THE PLANS AND SPECIFICATIONS +�
$
TOTAL FEES4.
HAS DONE 5erIN ACCORDANCE WITW ECTION"5541 OF THE BUSINESS AND PROFESSIONS
T F CALIFORNIAc" �'P •' '
r'
CASH ❑ CHECK [$M.O. ❑ ''
N.C. ❑
OWNER, .CONTRACTOR
rYyr�f��A1 'e.sG�.t«
"
t- y
RECEIVED BY
ADDRESS
ADDRESS
SEWAGE SYSTEMr
T _ LL a
P
CITY -
CITY.
TREES REQUIRED
YES
NO
INFORMATION
7 . NO.
TEL. NO. - LICENSE
FORM 284.208 (Rev. 11/721
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