208181 (MISC)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFET
COUNTY OF RIVERSIDE
VENT SYSTEM ❑ FAN ❑ EVAP.COOL ❑ HOOD
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
GARBAGE DISPOSAL
SQ. FT. @0
NO.
NO.
SQ. FT. Co)
FIXTURE OR SOCKET
SQ. FT. @ MOTOR 1 OR LESS H.P.
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
SQ. FT. @ MOTOR 5 OR LESS H.P.
WATER CLOSET
SQ. FT. CaMOTOR 20 OR LESS H.P.
DRAINAGE PIPING
SQ. FT. @
I DRINKING FOUNTAIN
SQ. FT. @0
UR'.NAL
OK.W.UNITS
WATER PIPING
ESTIMATED VALUATION $
INCINERATOR ❑ DOMESTIC [D INDUS. OR COMM.
FLOOR DRAIN
WATER HEATER
MECHANICAL FEES
SQ. FT. RESID. @ 1 q
WATER SOFTENFR
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 jCZ�HP
POLE
LAVATORY
APPLIANCE VENT
AMPERES SERV. ENT.
SHOWER
ABSORPTION SYSTEM B.T.U.
SQ. FT.@ q
EATH TUB
INCINERATOR ❑ DOMESTIC [D INDUS. OR COMM.
SQ. FT.@ q.
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SQ. FT. RESID. @ 1 q
SEWAGE DISPOSAL
BOILER E:::= B.T.U.
SQ. FT. GAR AGE @ z q
HOUSE SEWER
PERMIT FEE
BALANCE OF MIN. FEE
GAS PIPING
MOBILEHOME HOOKUP FEE I$ I I I I (PERMIT FEE I I ' I PERMIT FEE
PERMIT NUMBER TOTAL FEE.$ MOB. HOOK FEE . HEAT I1 VENT FEE DBL PLCK. FEE CONST. FEE JOBLI ELEC. FEE JOBLI FEE PLUMBING FEE DBL
O 8 {,p_Mv/J /1 --
J F M A M J J A S O
N D
.JOB ADDRESS
OWNER
73
USE OF BUILDING
F.C.
DATE
ER2I
O 08
R
74
.2 A T
r /yam
o mJLG
/
V
V1
755
COMMU ITY
DST
UNITS
OOM
VALUATION
SUPP. TO PERMIT
OFFICE
76
��
,�-
MOBILEHOME
$
LEGAL DESCRIPTION
HOOKUP FEE
jpG ?7y ` 3
DBL
SET BACK
LOT SIZE
ZONE
GRP
TYPE
CK BY
MECHANICAL FEE
$
L/(/
JUSENO.
F S R
BOND AMT.
PLAN NO.
PLAN CHECKER
FINAL DATE INSPECT
R
PLAN CHECK FEE
DBL
NAME OF CONST. LENDER
BRANCH OFFICE
NO LENDER INVOLVE
CONSTRUCTION FEE
$
DBL
ADDRESS
CITY STATE
ELECTRICAL FEE
$
$
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 60 DAYS.
CESSATION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
FEE
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
ORNIA. I ALSO AGREE TO ARRY COMPEN ION INSURANCE UPON MY EMPLOYEES.
COMPLIANCE WITH THE L S OF THE ST OF CALIFORNIA COVERING CONTRACTORS
IS ALSO GUARANTEED.Of
I HEREBY CERTIFY AT THE I IDU HO PREPARED THE PLANS AND SPECIFI-
TOTAL FEES $
CATIONS D E IN AC 0 A E ITH SECTION 5541 OF THE BUSINESS AND
PROF E STN F FORNIA.
CASH ❑ CHECK M.O. ❑ N.C.
CONTRACTOR
MWRy
Received eyo
p S
16FAY PA W44A
ADDRESS
Sewage System
T LL
P
CITY %/
CITY
Trees Required Yes
No
Lr
4j
INFORMATION
TEL. NO.
TEL. NO. LICENSE
FORM 284-208 (REV. 4/71)