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Z TDISTRICT[d0. GROUP ZONE PERMIT NO.
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NAME
UADDRESS /� � �+ CEI ED BY READY FOR DATEISSUCITY �'nwl. �-v TEL.NO. FIRST INSPECTION
COUNTYERT.NO. EXPIRES
APPLICANT FUMN HEAVILY OU LINEID PORTION ONLYJOB
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DESCRIPTION OF WORK -ADDRESS rl o ���ta A.. A2
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NUMBER OF OUTLETS ON CIRCUITS LOCALITY _ L
LOCATION BY ROOMS y
NEAREST � (I A)
LIGHT OUTLETS SW. PLUGS Fu[T CROSS ST.
CIRCUIT A S I C D E F G H W NAME
Z MAIL
ADDRESS
O
CITY _ TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
CORIIECTIONS
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Z_
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IOTAL
NO. OR OUTLETS $ r APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
i
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS ;POWER
PERMIT FEE $ �� UTILITY CO.NOTIFIED
TOTA -=FEE