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APPLICATION FOR ELECTRIC PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS �' �r
JOHN A LAMBIE COUNTY ENGINEER 1�
CA ATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMT FEES CROSSST
I)T E MNUMBER EACH FEE OWNER
OUTLETS $ MAIL
LIGHTS RECEPT SW 10 ADDRESS 4 ,p
d
LIGHTING FIXTURES 10 CITY If I TEL NO
ELEC RANGES CLO DRYERS ELECTRICIAN I ,G
WATER HEATERS 50 ADDRESS t
ELEC SPACE HTRS DISHWASHERS CITY ,,, TEL O
GARBAGE DISPOSERS AUTO STATE
WASHERS STA COOKING UNITS 25 LICENSE NO
MOTORS OVER INC H P DISTRICT NO jGROLJPj ZONE rPROCESSEED BY
y—
1/2/
O— 1/z 25 .r'""' f� / I 4
1/2- 2 50 INSPECTION RECORD
2— 5 too
5— 15 ISO
15— 50 250
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50-200 500
SIGNS NO TRANS
NO LAMPS
SERVICE O 600!
SERVICE OVER 660V Boo
MISC
WIRING PERMIT 100
FIXTURE PERMIT too
SUPPLEMENTARY PERMIT SO
TOTAL FEE $ /;
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR S SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR WIRING
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT 1 AM THE LEGAL T
jOF THE ABOVE
DESCRIBED RESIDENTIALt-PROPERTY 1 POWER
1
SIGNATURE / ,/ 1 ¢� � UTILITYCO NOTIFIED
OF PERMITTE
FINAL
®P vFjMATION(� ARTHUR C VETT
CK MO CASH�/f� SUPERVISING ELECTRICAL ENGINEER
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