272495 (SFD)FIELD OFFICE
BUILDING PERMIT DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
DST
1 ST FL.
2ND FL.
POR.
GAR. f{/
CAR P.
WALL
E�JSQ,
ESTIMATED CONSTRUCTION
SQ.FT. @ I f
SQ. FT- @
SQ.FT. @
SQ, FT. @ '—
SQ.FT.
SCE. FT. @
—
UNITS
YARD SPKLR SYSTEM
MOBILEHOMESVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
FT, @
VALUATION
t
WATER PIPING
NOTE: Not to be used as property tax valuation
SWIM POOL, PVT
FLOOR DRAIN
MECHANICAL FEES
SWIM POOL, COMM
WATER SOFTENER
VENT SYSTEM b FAN ❑ EVAP. COOL HOOD
SIGN
!
WASHER IAUTOI LWShtt-
APPLIANCE
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IDLE METER
J
KITCHEN SINK
..
.ABSORPTION SYSTEM 0 B.T.U-
TEMP USE PERM SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMP/PERM
LAVATORY
HEATING SYSTEM] FORCED ❑ GRAVITY
AMPERES SERV ENT
SHOWER
BOILER � B.T-U.
SQ FT @ c
!
BATH TUB
SQ FT @ a
WATER HEATER
SQ FT RESID r@r/.fib
/
r
SEWAGE DISPOSAL
•
?
i SQFTGARAGE @:^,'!3¢
H
HOUSESEWER
PERMIT FEE
GAS PIPING
MOBILE HOME PERMIT FEE
J
PERMIT FEE
_
j
PERMIT FEE
2E MffrATluQ
TOTRS FEES
MOB: HM.FEE
MICRO FE;j
MECH FEE
I DEL
PL CK FEE C0N5T FEE
DEL
ELECT. FE
DEL
I SMI FEE
FEE
PLUMB FEE
DBL
1
F
M
A
M
J
J
S
O
N
D
JOB ADDRESS ��— SP NO
OVINER�
'
74
75
USE OF PERMIT F.C.PATE
J"�'A fly �,.
j ,1
P Aq
1 495
76
, _ . `
M H PERMIT FEE
$
COMA1UNITY DST UNITS
ROOMS
VALUATION PERMIT
OFFICE
JSUPP.TO
I
MICROFILM FEE
COPIES
$
LEGAL DESCRIPTION _
4.
MECHANICAL FEE
DBL
$
SET BACK
LOT SIZE ZONE
USE NO
GRP TYPE
CK BY
PLAN CHECK FEE
$
BOND AMT-
PLAN NO-
PLAN CHECKER
FINAL DATE N+fECTOR
!t-1 M.
CONSTRUCTION FEE
DBL
$
NAME OF CONST, LENDER BRANCH
OFFICE
NO LENDER INVOLVED
ELECTRICAL FEE
DBL
$
ADDRESS CITY
STATE
r
STRONG MOTION
$
OWNER/AGENT'S SIGNATURE
C❑C TP: AC I'OR .
INSTRUMENTATION FEE
'
_ f .
,%•
L; /
$
ADDRESS
ADDRESS _
FEE
PLUMBING FEE
DBL
$
CITY ZIP CODE
CITY - ZIP CODE
$
TEL NO
TfL NO LICENSE
TOTAL FEES
J .r
-R '
CASH ❑ CHECK,® M.O. ❑ N C. ❑
THIS PERMIT SHALL BECOME VOID IF WORK IS NOT COMMENCED WITHIN 120 DAYS..CESSA
TION OF WORK FOR 120 DAYS SHALL ALSO CAUSE PERMIT TO BECOME VOID.
RECEIVED BY
TREES REQUIRED
ivl
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS PERMIT WILL BE DONE IN AC
CORDANCE WITH THE LAWS OF RIVERSIDE COUNTY AND THE STATE OF CALIFORNIA, I ALSC
SEWAGE SYSTEM
Y !
AGREE TO CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLIANCE WITHTH(
T
LL
Pr.
^ IJHEREB), CERTIFY THAT THE INDIVIDUAL WHO PREPAREDTHEPLANS AND SPECIFICATIONS
FORM 284-208 (Rev 10-74) (k)L I HAS DONE SO IN ACCORDANCE WITH SECTION 55-11 OF THE BUSINESS AND PROFESSIONS CODE
OFTHE STATE OF CALIFORNIA.- J