HomeMy Public PortalAbout9557BISBY ST_Electrical 7/A4,43C- CK.o.: 12115 APPLICATION FOR ELECT ICAL PERMIT
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BUILDI ND SAFETY DIVISION
FOR APPLICANT TO RILL IN JOB
New Residential Bldgs&Pools
EACH NO.1 FEE ADDRESS
1 &2 Finally Sq. Ft $ — $ LOCALITY
Multi-family Sq. Ft — NEAREST
CROSS ST.
Resldentlel Swimming Pools OWNER OR
FIRM NAME
Outlets: Light,Switch&Receptacle MAI L
Firrt 20 ADDRESS
Additlbnel CITY Tel. No. 10
PLAN CHECK
Lighting Fixtures APPLICANT
Firm 20 ADDRESS
Additional CITY Tel. No.
PERMIT
Fixed Appllanoes Not Over 1 HP APPLICANT
Range— Heater— D.W. ADDRESS
Oven Dryer W.M-
Top FAU W.H. CITY /I. No.
Hood Fen L LICENSE OR p
Clans.
REG. NUMBERc�
Disp. A.c.
I HERESY ACKNOWLEDGE THAT I HAV/ READ THIS APPLICATION
AND ■TAT■ THAT THE ABOVE 1/ CORRECT AND AGREE TO COMPLY U
Power Appamtus& Large Appllancm WITH ALL COUNTY ORDINANCES AND STATE L *S REGULATING W
Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING. N
U to 1 Incl.
P IHERE/Y CERTIFY THAT 1 AM PROPERLY wEGI/TEREO AND/Ow
Over 1 to 10 Incl. LICEN/ED AS REQUIRED BY LOS AN/ELKS COUNTY AND STATE OF
-Ove... G!1 CALIPORNU\ OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
Vr 10 to W Incl. DE/CRI/EO RE/IDENTIAL ERTY.
Over 60 to 100 Incl. PERMITEE
Over 100 SIGNATURE
Services I TRI O. RO SSE B
0-200 Amp. Under 600.V
d�
201 -1000 Amp. Under 600 V APPROVALS DATE R
Over 1000 Amip.or Over 600 V SIGNATURE
TEMP. POWER POLE
Temp. Power Pole&Appurtenances UNDERSLAB WORK
Sign with One Branch CircuitAdditional Sign Branch Circuits ROUGH CONDUIT
(Other) WIRING Q'
]FIXTURES
POWER AUTHORIZED
PERMIT FEE (Sub-Total) jIN
jL
.NOTIFIED !/ -27-17
PLAN CHECKING FEE One-Fourth Permit Fee r
C C ( ) — v
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PERMIT ISSUING FEE TOTAL FEE �~
PLAN CHECK VALIDATION CK. M.O. C SH IT VALIDAMNCK. M.O. CASH
-13 .7 'cc MA 17 2 D 3 4.0 0 �