176939 (CSCS)DEPARTMENT OF BUILDING & SAFETY
VENT SYSTEM A FAN VEVAP. COOL ❑ HOOD
MO -OR
COUNTY OPRIVERSIDE
LOT SIZE
FIELD OFFICE
WASHER (AUTO) (DISH)
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
Por.
Gar.
Car P.
i 7
Sq. Ft. vW-``'� 4
Sq. Ft. @
NO.
GARBAGE DISPOSAL
NO.
Sq. Ft. @
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
Sq. Ft. @ POLES
Sq. Ft. @ SIGNS
DRAINAGE PIPING
TRNWall Sq. Ft. @ ORFT.SCLK.O/
DRINKING FOUNTAIN
Sq. Ft. @ MO -OR H. P.
URINAL
MO -OR M.P.
WATER PIPING
ESTIMATED VALUATION Is
��rr MOOR
H. P.
FLOOR DRAIN
F.C.
MECHANICAL FEES
I I .., _
-
VENT SYSTEM A FAN VEVAP. COOL ❑ HOOD
MO -OR
H. P.
LOT SIZE
WASHER (AUTO) (DISH)
JOB ADDREI /' OWNER
APPLIANCE
FI%rURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
ZONE
USFt OF BUI_DING
LAUNDRY TRAY
PLAN CHECK FEE $
ri
AIR HANDLING UNIT
SUB -PANEL
�` `�
KITCHEN SINK
COMM N fT Y" - DISTRICT
F.C.
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
J
OFFICE
s`
G
v (1
WATER CLOSET
COMPRESSOR O HP
IV
WA_ E AND/OR
OVEN
LAVATORY
9YPE
�..y�
APPLIANCE VENT
WA -ER HEATER
CONSTRUCTION FEE $
SHOWER
ABSORPTION SYSTEM D B.T.U.
SPACE HEATER
SPEC. IN5P.
BATH TUB
SUPP. TO PERMIT
ELECTRICAL FEE $
INCINERATOR DOMESTIC ❑ INDUS. 11 COMM.
CONSTRUCTION
POLE
r
WATER HEATER
PLAN CHECKER
BOND $ i
HEATING SYSTEM �I FORCED ❑ GRAVITY
f` .� CC EN
N� E�- �
FINAL DATE
!
SEWAGE DISPOSAL
�-
6BOILER
D B.T.U.
[SE5R.VVII
BEr
Si iT SO.
FT.
[ •�� - /6
HOUSE SEWER
TOTAL FEES
PERMIT FEE
GARAGE zQ SO.
FT.
TH S PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
GAS PIPING
i
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 FEE
RECEIVED BY
r w f4
SEWAGE SYSTEM
PERMIT FEEL
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
PERMIT NUMBER REN, DBL. TOTAL FES HEAT 8 VENT FEE PLN.yCCO, ,FEE CONST. FEE ELEC. FEE PLUMB. FEE( -...,
J
J
.� �i-rte "�'.r �.%ti•�` �.,l . � � �t �' �,,. '� �� ^'s..► ~
Pis
s
17693
J F M A M J
J F n - I u ... '
SET BACK
LOT SIZE
USE # �')
JOB ADDREI /' OWNER
2
'
ZONE
USFt OF BUI_DING
DDA E'%,r
PLAN CHECK FEE $
ri
_�
..^"'� ��I•
�` `�
C ECKED BY
COMM N fT Y" - DISTRICT
F.C.
VALUATION
OFFICE
MECHANICAL FEE $
v (1
JUNITS
GROUP
9YPE
LEGAL D S eR IPTION
176939
PERMIT NUMBER
CONSTRUCTION FEE $
SPEC. IN5P.
SUPP. TO PERMIT
ELECTRICAL FEE $
.-014 /„ �. " �•, i
PLAN CHECKER
BOND $ i
BOND
CASH
PLAN FILE 0
FINAL DATE
IN • ECTOR
PLUMBING FEE $ 4/
�-
I
[ •�� - /6
TOTAL FEES
TH S PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED
i
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. I N.C.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
gze4-T'�'5
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
LL
P4121
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON -
NAME OF CONSTRUCTION LENDER
TRACTORS IS ALSO GUARANTEED.
OWNER
CONTRACTOR '
BRANCH OFFICE{`
�~
ADDRESS
_ "�
4DRE55
ADDRESS
CITU
STATE
�+ �' ,-y
}
i �•�
NO LENDER INVOLVED
INFORMATION
TEL. NO.
TEL. NO.
T/
LICENSE NO. •`
284-208 12/68
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