HomeMy Public PortalAbout4937AGNES AVE_Electrical D B S SA 25M SETS 10 47 �Pg Af'1 AIY�Q wT 11�A1D PII�tA1,�1171� `
DEPARTMENT �� BlJ1LJVl1\� e�� SAFETY i �a•e�'LJL'LEYAC1� FOR 11GC�1�1.8.�
COUNTY OF LOS ANGELES
CHIEF ENGINEER
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NAME DISTRICT NO GROUPZONE PERMIT NO
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ADDRESS i0
IU_ CITY r TEL NO �`� B REC LVED BY READY FOR DATE ISSUED
COUNTY FIRST INSPECTION
CERT NO Z(o EXPI ES z - Y
APPLICANT FILL IN HEAVILY OAALINED PORTIO ONLY
JOB
DESCRIP'T'ION OF WORKADDRESS �� .. Y
NUMBER OF OUTLETS ON CIRCUITS LOCALITY / s G
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS' SW PLUGS FIXT[CROSS ST
CIRCUIT A B C D I E F G H 10: NAME -`A/t'
' Z MAIL
,: ADDRESS
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CITY TEL 110
1 AM THE LEGAL POSSESSOR Q
THP
ABOVE LOS
ANGELES COUNTY CERTIFICAA O QU KATION
o '
i ELECTRICIAN
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
Iq( ABOVE
�i /(�� OWNER
CORRECTIONS
I
s Q
_Z
r B
O
J
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TOTAL
NO OF OUTLETS APPROVALS
a�
NO OF FIXTURES $ DATE INSPECTOR S NAME
NO OF MOTORS HIM $ I CONDUIT
NO OF SIGNS TRANS $ WIRING
N9-AFR/kNE,ES OR HEATERS FIXTURES
MI CE NEOU9 $ POWER
a z
PERMIT FEE $ UTILITYCO NOTIFIED
J_TOTAL FEE $ FINA — 71 ix