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APPLICATION FOR PERMIT
DEPAStMENT OFLOS NG AND SAFEELECTRIC 1
COUNTY OFF TY
LOS ANGELES
WILLIAM J. FOX, CNIEr ENGINEER
FOR AP LICANT TO FILL IN DISTRICT NO GROUP ZONE rPERMIT MO.
ELECTRICIAN
[IVSD BY READY FOR DAT[ ISSUED
ADDRESS L FIRST INSPECTION
CITY TEL. NO
COUNTY LICENSE NO 7► PIKES BUILDING
FEES
PEBIIOT ADORES➢ 3 NA 1 !
FEE
NUMBER EACH LOCALITY
LIGHT OUTLLTB NEAREST
CRDBB ST
R[C[PTAOLEB Q
WALL SWITCHEB OWNE
TOTAL OUTLETS SC d MAIL
ELEC RANSES 93 ADDR[
ELEC HEATERS YS CITY TEL NO
FIXTURES 6 G 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING
MOTORS 1 CERTIFY THAT 1 POGUE" THE ABOVE VALID LOB
NUM7 HORSEPOWER ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
rcc
N[w MVC HP .YKR pa [AC. Or THE RESIDENTIAL PROPE COCRIBED ABOVE
V a "as S 23 SIGNATURE F
B SO PERMITTf ____ __
S B 1GO INSPECTION RECORD
S 16 1 BO
1S BO 9 SO
BO 10O B 00
900 Soo lC 00 J
SOD IOOC 16 OO =
OVER 1DOC IID OO
M G MT/rRtQ CHANGER-HP Q'
WELDERS AC-KVA O
GENERATORS
TRANSFORMERS - KVA
TEMP MOTORS (75at aala I
MOVED MOTORS (75% ar Cam)
MIBC
SIGNS
NNO NO LO NO TRANS. APPROVALS
AMPS
-FOR EACH PERMIT DAT[ INSPECTORIUMAME
WIRING 919030 CONDUIT
rIKTUR[S 01.00 OG WIRING
RUPPLMMENTARY 60 rI)(TURES
o POWER
TOTAL FEE S / / UTILITYCO NOTIFIED /f
VVV FINAL !