290178 (SATT)DEPARTMENT OF BUILDING & SAFETY
BuuDING.PERMIT COUNTY OF RIVERSIDE
PERMIT NO.
NO. I ELECTRICAL FEES
UNITS
> MOBILEHOME SVC.
C POWER OUTLET
POOL, PVT
FIELD OFFICE .
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
// I
MECHANICAL -FEES
N D
SWIM POOL, COMM
a
WATER SOFTENER
CONSTRUCTION ESTIMATE
1 ST FL.
ice.
SQ. FT. @ $
" 2ND FL.
WASHER(AUTO) ISH)
SQ. FT. @
I APPLIANCE RYER
.
D'dl
` POR.
GARBAGE DISPOSAL
SQ. FT.- @
' GAR.
F.C.
SQ. FT. @
PERMIT NO.
LAUNDRY TRAY
'•CAR P.
SQ. FT. @ -
WALL
KITCHEN SINK
SQ. FT. @
' ABSORPTION SYSTEM B.T.U.
SQ. FT. @
ESTIMATED CONSTRUCTION
VALUATION $ d
,.. NOTE. Not to be used as property tax valuation
NO. I ELECTRICAL FEES
UNITS
> MOBILEHOME SVC.
C POWER OUTLET
POOL, PVT
FIELD OFFICE .
NO. PLUMBING FEES
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
FLOOR DRAIN
// I
MECHANICAL -FEES
N D
SWIM POOL, COMM
OWNER
,
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL XHOOD
ice.
SIGN
VA ATION
$ 5
WASHER(AUTO) ISH)
DST OFFICE
I APPLIANCE RYER
.
M H PERMIT FEE
GARBAGE DISPOSAL
IGtCJ
p FURNACE ❑ UNIT ❑ WALL ❑ FLOOR. ❑ SUSPENDED'
F.C.
SUPP! TO rERMTr
PERMIT NO.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
KITCHEN SINK
r'
' ABSORPTION SYSTEM B.T.U.
TEMP USE PERM SVC
WATER CLOSET
¢717
' COMPRESSOR HP
C
POLE, TEMP/PERM
LAVATORYTI
G'
HEATING SYSTEMORCED .❑ GRAVITY
G?
MPERES SERV ENT
LSHOWER
LEGAL DESCRIPTION
BOILER B.T.U.
SQ.FT. @ a
BATH TUB
la t-
"
$
SQ.FT. @ aWATER
USE NO.
HEATER
!!
LOT SIZE
GRP TYPE CK BY
Q.FT.RESID @ 11/aa
If
SEWAGE DISPOSAL?
SQ.FT.GAR @ 3/k
HOUSE SEWER.
GAS PIPING
PERMIT FEE
%
PERMIT FEE
PERMIT FEE
!'
DBL.
I TOTAL FEES - IMOB.HM.FEEI
- MICRO FEE
MECH. FEE
B4
F E
CONST. FEE
ELECT. FEE
%
SMI FEE
FEE
PL MB. FEE
B
_
J F M' A M 1 J A S O
N D
JOB ADDRESS SP NO
r, I
116
OWNER
,
76
77
COMMUNITY
VA ATION
$ 5
DATE
e,
DST OFFICE
�7B
M H PERMIT FEE
$
sE OF ER 1
F.C.
SUPP! TO rERMTr
PERMIT NO.
2901MICROFILM
FEE
COPIES
$
BOOK IPAGE PARCEL
LEGAL DESCRIPTION
MECHANICAL FEE..
DBL.'
$
USE NO.
ZONE
SET BACK
LOT SIZE
GRP TYPE CK BY
)
?LAN CHECK FEE..
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE I
PECTOR'
CONSTRUCTION FEE
DBL
$ fl
NAME OF CONST. LENDER 4p BRANCH
OFFICE •
NOLENDER INVOLVED
ELECTRICAL FEE
DBL
$�
ADDRESS. CITY
STATE
�TRONG MOTION
$
6f
OWNER/AGENTS SIGNATURE CONTRACTORy
_.� y? •fir
INSTRUMENTATION FEE
/�J
t, !
SPECIAL INSP
$
ADDRESS ADDRESS
`
DEMOLITION
FEE
REGISTRATION
L✓ t
PLUMBING FEE
DBL
$0
CITY ZIP CODE CITY
ZIP
pCODE
TOTAL FEES
$
TEL. NO. AREA
CODE TEL.
NO. IF IREADE
LICENSE cjr❑CHEC
.
❑❑M.O.N.C.
RECEIVED BY,.
EES REQUIRED
T. S IT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS. CESSATION OF
` Z
120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
t' I Y AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN ACCORDANCE
T
SEWAGE SYSTEM
!i
T
LL
P {7 �q�
LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSO AGREE TO CARRY
R (IAADCAIf ATIllwl �w�fi
CALIFORNIA COVERING CONTRACTORS IS ALSO GUARANTEED.•
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFICATIONS HAS DONE
SO IN ACCORDANCE WITH SECTION 5541 OF THE BUSINESS AND PROFESSIONS CODE OF THE STATE
FORM 284-208 (REV. 6-761 OF CALIFORNIA.