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DEPARTMENT OF BUILDING AND SAI♦M APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ]ELECTRIC
M J FOX CHIEF ENGINEER
Q NAME w �� � � DISTRI T NO GROUP ZONE �PERMIT NO
ADDRESS
F O RECEI D BY READY FOR DATE ISSUED
W CITY� a � � TEL NO " i FIRST LECTION i r �
.J COUNTY
W I CERT NO rf EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLYJOB
(DESCRIPTION OF WORD ADDRESS C/ ems/ CRGB
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS ISW PLUGS FIXT CROSS ST
CIRCUIT A B C D E F G I H NAME
ZMAIL ��yy
ADDRESS
O
CITY TEL NO
1
AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGLES, COUNTY CERTIFICATE'OF QUALIFICATION y
o dI ELECTRICIAN
AI AM
BOVE THC LEGAL OWNER OF THE PROPERTY DESCRIBED
OWNER
CORRECTIONS
A
Fl
� v fir/ Z
r 0
o
v v7V
I "
TOTAL
NO OF OUTLETS $ APPROVALS
NO OF FIXTURES $ DATE INSPECTOR S NAME
NO OF MOTORS H P $ CONDUIT
NO OF SIGNS TPANS $ WIRING
NO OF RANGES OR HEATERS $ FIXTURES
rPERMIT
LANEOUS $ POWER
FEE $ 00 UTILITYCO NOTIFIED
FEE FINAL !