176662 (AR)DEPARTMENT OF BUILDING & SAFETY
COUNTY OF RIVERSIDE
FIELD OFFICE
CONSTRUCTION ESTIMATE
ELECTRICAL FEES
PLUMBING FEES
1st FI.
2nd FI.
T
Par. IP
Gar.
Car P.
Wall
Sq. Ft. @
Sq. Ft. @
Sq. Ft. @ Zv
Sq. Ft. @
Sq. Ft. @
Sq. Ft. @
Sq. Ft. @
NO.
NO.
-0 v
r v
POLES
-
SIGNS
DRAINAGE PIPING
TRANS. AND/
OR T. CLK.
DRINKING FOUNTAIN
MOTOR H.P.
URINAL
MOTOR H.P.
WATER PIPING
ESTIMATED VALUATION $
MOTOR H.P.
FLOOR DRAIN
MECHANICAL FEES
MOTOR H.P.
WATER SOFTENER
VENT SYSTEM ❑ FAN ❑ EVAP. COOL ❑ HOOD
MOTOR H.P.
WASHER (AUTO) (DISH)
APPLIANCE
FIXTURES
GARBAGE DISPOSAL
FURNACE ❑ UNIT ❑ WALL ❑ FLOOR ❑ SUSPENDED
OUTLETS
LAUNDRY TRAY
AIR HANDLING UNIT
SUB -PANEL
KITCHEN SINK
GAS PIPE ❑ NATURAL ❑ L.P.G. ❑ OIL
WATER CLOSET
COMPRESSOR �HP
RANGE AND/OR OVEN
LAVATORY
APPLIANCE VENT
WATER HEATER
SHOWER
ABSORPTION SYSTEM B.T.U.
SPACE HEATER
BATH TUB
INCINERATOR DOMESTIC ❑ INDUS. ❑ COMM.
CONSTRUCTION POLE
WATER HEATER
HEATING SYSTEM ❑ FORCED ❑ GRAVITY
SERVICE ENTRANC
11
5..!
SEWAGE DISPOSAL
I
BOILER B.T.U.
RESID. 10 SQ. FT.
HOUSE SEWER
PERMIT FEE
I
GARAGE zQ SQ. FT.
'7
�r`
GAS PIPING
PERMIT FEE
V
PERMIT FEE
P T
U
B
IREN.
DBL.
TOTAL FEEg
HEAT 3 VENT FE PLN. CK. FEE
CONST. FEE ELEC.. FEE PLUMB. FEE
�. F__ M A tw1 J J h
J F M A M J J A S
N- D
O N D
SET BACK
LOT SIZE
USE #
JOB ADDRESS
OWNER
u'o
F
S R
'
v�
ZONE
US OF BUILDING
fl
bmA 4i `')
PLAN CHECK FEE $
' ,
�o
CHECKED BY
COMMUNITYTRICT
F.C.
VALUATI N
OF C'�
7--
]UNITS
MECHANICAL FEE $
RO P
YPE
LEGAL D£5 P ITION
.PERMIT
NUMB
R
CONSTRUCTION FEE 5 f �] �V
176662
SPEC. INSP,
SUPP. TO PERMIT
ELECTRICAL FEE $
_ �-
PLAN CHECKER
BOND E
ND
ASH-
PLA F LE # FINAL DATE
INSP CTOR
PLUMBING FEE $
✓ /O�•��
.#
TOTAL FEES 90
THIS ME VOID I ENCED
HALL OOF
RMIT SCESSATION R1201
WI WITHIN 60EDAYS. WORK FOR DAYS SHALL ALSO
CAUSE PERMIT TO BECOME VOID.
I HEREBY AGREE THAT ALL WORK IN CONNECTION WITH THIS
CASH CHECK M.O. N.C.
RECEIVED BY
SEWAGE SYSTEM
PERMIT WILL BE DONE IN ACCORDANCE WITH THE LAWS OF RIVER-
ILL
SIDE COUNTY AND THE STATE OF CALIFORNIA. I ALSO AGREE TO
2i" 1
T
P
CARRY COMPENSATION INSURANCE UPON MY EMPLOYEES. COMPLI-
ANCE WITH LAWS OF THE STATE OF CALIFORNIA COVERING CON-
TRACTORS IS ALSO GUARANTEED.
NAME OF CONSTRUCT[Or4 LENDER
OWNER -,
CONTRACTOR
15RANCH OFFICE
ADDRESS
ADDRE55
ADDRESS
CITY STATE
-
!
NO LENDER INVOLVED
INFORMATION
TEL. NO,
TEL. NO.
LICENSE NO.
284-208 12/68
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