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TSA 6610El 6.62 APPLICATION FOR ELECTRICAL PEkMIT
COUNTY OF LOS ANGELEB
DEPARTMENT OF COUNTY ENGINEEReuILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN. Our T or 6uILDING LOCALITY
FORNEAREST
C O A IN CROSS BT
RECEPT -� TOTAL no EACH FKE
OUTLETS FIRST 20 *20111 OWNER
AD.LIGHT MAIL '
SWITCH OVERADO'L f0 ADDRESS
GHTING
LTOTAL r'lRar 20 10 m C _ TEL NO
�I
FIXTURES ADD'L OVFR 20 10 ELECTRICIAN
RANGES B writ xrRe too ADDRESS
GA1m DIW STA COOK -
CITY T!L NO
D1S11WASX AUTO WAIx STATE
SPA"HTRS STA AIF fit HJ MAX) 60 LICENSE NO
MOTORS, ovER NOTOVER HP DISTRICT NO I GTUP I ONE P E D BY
1 3 160 5, INSPECTION RECORD
3 — S 200
6 16 250
• Is — so 300 d
60 — foo 600 0
SIGNS, NO TRANS d
No u1PRO
SERVICE O 600V NOT DYER 200A 1 oo ITj
6
SEAVIC!O SOON Ovu 200 A 200 Z
SERVICE OVER 600V 600 —
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE 100
TOTAL FEE 6
F
1 xEREIY ACKNOWLEDGE THAT I HAVE READ TI112 APPLICATION TK INmXcTGE a"I TURK
AND ETATK T T THE ABOVE IE CORRECT AND AGREE TO COMELY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE uWE REGULATING
ELECi1RCAL WIRING WIRING
1 HEROY CERTIFY THAT 1 AN FROFERLT R[OIREIIED AMDiM
LICENI[o EQLAL AS REQUIRED BY on NGXCOUNTY AND STATE Or FIXTURES
CALIFORNIA OR THAT I AN THE LEGAL OWNER OR THE ABOVE
OEDCRISED RESIDENTIAL FRQRXEYY POWER'
SIGNATURE UTILITY CO NOTIPI i
OF PERMITTER FINAL _
VALID A HUR C VETT
SUPERVISING VETT ELECTRICAL ENGINEER
n CR M CASH
Lf*8'7'7'7ta AVG-1, 2 2 0 ' 2.00- 0