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DBS
APPF.ICATION FOR PERMT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ELECTRIC
WM J FOX HIEF ENGINEER e
Q NAME DISTRICT NO GROUP I ZONE PERMIT NO
u ADDRESS I Z 40.1.." K2047
CITY TEL NO _t I RE"EIVED BY READY FOR DATE ISSUED
W FI INSPECTION
CERT NOCOUNTY D e EXPIRES 0'3/ 41 b g �" 1
�
APPLICANT FILL IN HEAVILY OU'T'LINED PORTION ,O/vNI/.,AYJOBA
DESCRIPTION OF WORK ADDRESS
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW PLUGS FIxT CROSS ST _ ,
CIR)CUIT A B C D E� F G H m �y NAME �C(/ r
4 t0_014-
/_ Z MAIL
(Q 3 ADDRESS
' / O CITY TEL NO
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CER TL p OF QUALIFICATION
/ 1 ELCCTRICIAN
s i AM THC LEGiAAL.OWNER OF THE PROPERTY DESLRIBCD
N ABOVE
tl
� OWNER
' tl COMECTIONS
0.
4 Q
o Z
1 _
91
,
{
TOTAL 4p,
NO OF OUTLETS $ 9, i APPROVALS
� 1
I NO OF FIXTURES 5 I DATE i INSPECTO S NAME
NO OF MOTORS H 4P $ I CONDUIT 4Y
S
NO OF SIGNS TRANS $ I WIRING
b
NO OF RANGES OR HEATERS $ �FIYTURES
,
MISCELLANEOUS $ POWFR
PERMIT FEE $ UTILITY CO NOTII'IED
TOTAL FEE A ® FINAT IS r