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DBSSS3A 9 35 APPLICATION
py ®PLICATION FOR ELECTRIC PERMIT
A
DIVISION OF BUILDING AND SAFETY _
It Deportment of County Engmeer
County of Los Angeles BUILDING ¢ T/�J�L�S��G,/��
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST
NUMBER EACH FEE r+k
OWNER ` e O .\J
LIGHT OUTLETS -
RECEPTACLES ` MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS I 5¢ S Q CITY TEL NO
ELEC RANGES 25 ELECTRICIAN
ELEC HEATERS 25 ADDRESS
KW EA CITY TEL NO
FIXTURES 5 LICENSE NO
NUMBER OF LIGHT CIRCUITS
DISTRICT NO f GROUP ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS
MOTORS
NUMBER I HORSEPOWERFEE INSPECTION RECORD
NEW MVD HP OVER INC EACH
&LESS S 25
1/2 2 50
2 5 1 00
5 15 1 50
15 50 2 50
50 200 5 00
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $100
FIXTURES $1 00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE $ 0 DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP Lj
CONDUIT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGWIRING
ELECTRICAL WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND SCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THEPOWER
DESCRIBED RESIDENTIAL PR PERTY a I
UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELECT INSPECTOR
fjo5 2 1 6u.,-, JUN 30 2 105 in