269924 (RPL)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
. ' CONSTRUCTION ESTIMATE
ST FL.
SQ.FT. @
_ 2ND FL.
SQ. FT. @
POR.
SQ. FT. @
GAR.
SQ. FT. @
CAR P.
SQ.FT. @
WALLSQ.
FT. @
TEMP USE PERM SVC
WATER CLOSET
ESTIMATED CONSTRUCTION VALUATION $
NOTE: Not to be used os property tbx voluotion
LAVATORY
KApr-HANII(-Al FFF(Z
NO. ELECTRICAL FEES
UNIT..
i MOB LEHOME SVC.
POW :R OUTLET "
SWIM POOL, PVT
-WIAP Pr)r)i rf1AAAA
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL '
WATER PIPING '
FLOOR DRAIN
%A/ATPD C(1CTCAICD
DST
/Y
VENT SYSTEM O FAN. O EVAP. COOL ❑HOOD
SIGN
WASHER (AUTO)IDISHI '
APPLIANCE
GARBAGE DISPOSAL
FURNACE Cl UNIT O WALL' O FLOOR O SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE N.ETER
KITCHEN SINK
ABSORPTION SYSTEM 0 B.T.U.
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM O FORCED O GRAVITY
AMPEt!E5SERV ENT
SHOWER
BOILER � B.T.U.
SQ FT @ a
BATH TUB
DST
SQ FT @ a
WATER HEATER E
VALUATION
SQ FT RESID @ 1 ¢
SEWAGE DISPOSAL
S'D FT GARAGE,@ I/x¢
HOUSE SEWER
PERMIT FEE !
GAS PIPING
MOBILE HOME PERMIT FEE
2 6EM19 2 4 >"3
)B. HM.FEE :M�ICRO FEE MECH. FE
¢•
PERMF FEE " PERMIT FEE
PL. CK FEE CONST. FEEDBL. ELE,6T. FEE D.L. SMI FE5r fEE PLUMB. FEE DBL.
'J F M A M J J A S O N D
.JOB ADDRESS SP NO
OWNE:
75
USE OF PERMITF.C.
DATE
P M N
M H PERMIT FEE$
COMMUNITY
DST
UNITS
ROOMS
VALUATION
SUPP. TO PERMIT
OFFICE
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION
MECHANICAL FEE
DBL
$
SET BACK LOT SIZE ZONE`
USE NO.
GRP
TYPE
BY
JJ"
I
ICK
PLAN CHECK FEE '
$
BOND AMT.
PLAN NO. PLAN CHECKER,
FINAL D` /
INSPECTOR'
j
I
CONSTRUCTION FEE
DBL
$ '
NAME OF CONST. LENDER' BRANCH
OFFIC-
NO LENDER NVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS ' CITY
STATE
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE Y f
CONTRACTOR _
INSTRUMENTATION FEE .
'"–�+»---'
✓
J
7 0—
$
ADDRESS
ADDRESS ,
FEE
PLUMBI NGFEE
DBL
$
CITY ZIP CODE
CITY ZIP CODE
•
•
TOTAL FEES
TEL. NO.
TEL. NO. LICENSE
CASH O CHECK M.O. O N.C. O
THIS PERMIT SNAIL BECOME VOID IF WORK IS NOT =OMMENCED WITHIN 120 DAYS. CESSA
TION OF WORK FOR 20 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY .%^�`�r d� " ;TREES %QUIRED
,.
I HEREBY AGREE –HAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA,•1 ALSC
SEWAGE SYS EM
IT "'�!
LL
IP
AGREE TO CARRY CCMPENSATION INSURANCE UPON .AY EMPLOYEES. COMPLIANCE WITH THI
I AXA/C LIC TUC CT A TC l C!A I I CNOMI A /'!1\/PDIAI(_!• KITD. rTl DC IC A I Cn l_II A DA NITCCII
I HEREBY CERTIFI• THAT THE INDIVIDUAL WHO PRE'ARED THE PLANS AND SPECIFICATIONS
FORM 284-208 (Rev. 10-74) @L HAS DONE SO IN ACCORDANCE WITH SECTION.5541 OI THE BUSINESS AND PROFESSIONS CODE
1 OF THE STATE OF CAL FORNIA.