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76AW CE 10
10/72 APPLICATIONR E'LE RICAL PER MIT �71L�11
L -COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ADDRESS ✓e---
BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST /
FOR APPLICANT TO FILL IN CROSS ST ,�C
7�a
TS NO EACH FEE OWNER OR
$ $ FIRM NAME
MAIL
ADDRESSTOTAL FIRST 20 25 OO CITY TEL NO
� OVER 20 ID PLAN CANT
FIXTURES 10 K
TOTAL
LIGHTING 1 FIRST 20 25
)y
OVER 20 ADDRESS
RESIDENTIAL APPLIANCES CITY TEL NO -
PERMIT
RANGE-DRYER WTR HTR APPLICANT
STA COOK DISP F A U ADDRESS
SPACE HTR _AIR COND CITY TEL NO
CLOTHES WASH DISHWASH LICENSE OR CLASS
REG NUMBER
FAN OTHER 100 ^ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
L•� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND HEATERS ETC HP KW KVA ELECTRICAL WIRING
SIZE & TYPE OVER TO
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 IDD LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAI I AM THE LEGAL OWNER OF THE ABOVE d
1 - 10 300 DESCRIPED RESIDENTIAL R PERTY
1 C)
PERMITEE
10 - 50 flu SIGNATURE CD
F-
U
50 - 100 DISTRICT NO PR E ED BY 0-
100
N
1 00 - 500 a Z
SIGN GAS SIGN AND ONE CIRCUIT APPROVALS DATE INSPE RS SIGNATURE
TUBE OR
MARQUEE ADDITIONAL CIRCUITS TEMP POWER POLE
SERVICENOTOVER600VOLTSOR200AMP UNDERSLAB WORK
SERVICEOVER600VOLTSOR200AMP ROUGH CONDUIT Al ATEMP SERVICE POLE &APPURTENANCES WIRING � X57`3TEMP LIGHT OR RECEPT SYSTEM FIXTURES
POWER AUTHORIZED
UTILITY CO NOTIFIED
FINAL i
PERMIT FEE (SUB TOTAL) NOTES
PLAN CHECK FEE
PERMIT ISSUING FEE 300 G _f
TOTAL FEE
PLAN CHECK VALIDATION CK M 0 ` CASH PEf6liT VALIDATION M 0 CASH
5NSEELAP, 0 G G 9-3 WR 15 ? D 1 3 35-
SEE
BACK OF APPLICATION FOR COMPLETE SCHEDULE