217791 (SPIN)BUILDING PERMIT
SIGN
DEPARTMENT OF -BUILDING & SAFET
COUNTY OF RIVERSIDE
FIELD OFFICE -
TRANSFORMER =K•W•
CONSTRUCTION ESTIMATE
~. ELECTRICAL FEES
PLUMBING FEES
1ST FL. ,•
2ND FL.
POR.
GAR.
CAR P.
WALL
AIR HANDLING UNIT CFM
SQ. FT. @
KITCHEN SINK
NO.
NO.
SQ. FT. @
COMPRESSOR 0 HP
SQ. FT. Co) MOTOR 1 OR LESS H.P.
LAVATORY t
SQ. FT. @ MOTOR 5 OR LESS H.P.
AMPERES SERV. ENT.
SQ. FT. @ MOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT. @
URINAL
JK.W.UNITS
WATER PIPING
ESTIMATED VALUATION is
SEWAGE DISPOSAL
BOILER 0 B.T.U.
IFLOOR DRAIN
HOUSE SEWER
MECHANICAL FEES
BALANCE OF MIN:FEE
GAS PIPING
IWATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
SIGN
WASHER (AUTO) (DISH)
APPLIANCE
TRANSFORMER =K•W•
GARBAGE DISPOSAL
FURNACE❑UNIT ❑WALL❑FLOOR ❑SUSPENDED'
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIXTURE OR SOCKET
KITCHEN SINK
GAS PIPE (-]NATURAL ❑ L.P.G. ❑ OIL
CONST. SERV. ENTRANCE
WATER CLOSET
COMPRESSOR 0 HP
POLE
LAVATORY t
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM O B.T.U. '
SQ. FT.@ ?
BATH TUB
INCINERATOR ❑ DOMESTIC ❑ INDUS. OR COMM.
SQ. FT.@ 4'.
WATER HEATER
HEATING SYSTEM ❑ FORCED Cl GRAVITY
SQ. FT. RESID. @ 1'q
SEWAGE DISPOSAL
BOILER 0 B.T.U.
SQ. FT. GARAGE'@. -,L c
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN:FEE
GAS PIPING
MOBILEHOME HOOKUP FEE I$ I I I I. IPERMI-T FEE I I I I PERMIT FEE I I
PERMIT NUMBER I TOTAL FEE-j-1MOB. HOOK FEE "HEAT B VENTFEEDBL PL. CK. FEE CONST. FEE FE
EC. FE DBL FEE PLUMBING FEE DBL
J
J
J F M A M J J A S O
N D
JOB
/ADDRESS
�-�j
OWL//
/,� ,y
72
'7 �P J C. ,'5
1��,'ZC:�
73 -
USE OF BUILDING
F.C.
DATE
PE21j 7791
7 4
75
COMMUNLTY
DSTT•''"
UNITS
OOM
VALUATION
SUPP.�T7O PERMIT
OFFICE
76%%G�l.�/it�l
MOBILE HOME
FEE�(•
LEGAL DESCRIPTION
, ;-j
HOOKUP
!;
MECHANICAL FEE
DBL
$„�'
SET BACK •
LOT SIZE
ZONE .
USE NO.
GRP
TYPE
ICKSY
F' S R
PLAN CHECK FEE
$
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE - INSPECTOR
_
7 r
9
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVO VIED
CONSTRUCTION FEE
$
DBL
ADDRESS
CITY STATE
ELECTRICAL FEE
$,
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
FEE
�JV
�-•�
CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN;CONNECTION WITH THIS PERMIT WILL BE DONE
IN ACCORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIF -
DBL
PLUMBING FEE
$
ORNIA. I ALSO AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES.
COMPLIANCE WITH THE LAWS OF THE STATE OF CALIFORNIA COVERING CONTRACTORS
IS ALSO GUARANTEED.
I HEREBY CERTIFY THAT THE INDIVIDUAL WHO PREPARED THE PLANS AND SPECIFI-
)PRO ESSIONS CODE OFATIONS HAS DONE OTHE.STATIN ACCORDANCE
O CALI OITH RNIgSECTION 5541 OF THE BUSINESS AND
TOTAL FEES $ /
oG
CASH ❑ CHECK M.�. ❑ N.C. O
OW ER NTRACTOR
GI 1.
Received By
( fSS / 111 ADDRESS
k✓eP %C• o -
Sewage System T
LLQ
P
Trees Required
Yes
No'
CITY / CITY
/
IN YUHMA I IUN
FORM 284-208 (REV. 4/71)
TEL. NU.
:NSE