HomeMy Public PortalAbout5004AGNES AVE_Electrical (4) DO a A Io al 28M APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ELEC'T'RIC 1
COUNTY OF LOS ANGELES
WM J FOX CHIEF ENGINEER
NAME DISTRICT NO GROUP I ZONE PERMIT NO
ADDRESS
RECEIVED BY READY FOR DATE ISSUED
u CITY TEL NO ,q/^ FIRST INSPECTION
A
COUNTY
CERT NO EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
DESCRIPTION OF WORK ADDRESS � 'p
NUMBER OF OUTLETS ON CIRCUITS LOCALITY "A(rl (j
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS ISW PLUGS PIXT CROSS ST
CIRCUIT A B C D 1 E F G I H W NAME XZ MAIL
Q ADDRESS �s A
O
CITY TEL.NO
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGF3LSS COUNTY CERTIFICATE OF QUALIFICATION
ELECTRICIAU.,,
1 AM THE LEGAL OWNER PERTY DESCRIB
ABOVE
0
CORRECTIONS
'a
o
TOTAL
NO OF OUTLETS APPROVALS
NO OF FIXTURES s4 DATE INSPECTOR S NAME
NO OF MOTORS H P ffi CONDUIT
NO OF SIGNS TRANS ffi WIRING
NO OF RANGES OR HEATERS E FIXTURES
MISCELLANEOUS # POWER
PERMIT FEE E ® UTILITYCO NOTIFIED
TOTAL FEE a FINAL s-z Q��