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APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING �Y�a
BUILDING AND SAFETY DIVISION ADDRESS �J /
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY '
WA NEAREST %3')
FOR APPLICANT TO FILL IN CROSS ST t [�
RECEPT TOTAL NO EACH FEE
OUTLETS FIRST 20 $ 20 $ OWNER
LIGHT MAIL
ADDL f0 ADDRESS
SWITCH OVER 20
TOTAL
LIGHTING Flasr 20 CITY TEL NO
20 � a�
FIXTURES ADD L / f
Ov R 20 f0 ELECTRICIA
-AANeE3 CLO DRYERS MgJ1 44*RS 1 00 /,,
ADDRESS l !N
GARB DISP STA COOK Y /T
CITY ��✓� ,o TEL N o {�
DISHWASH AUTO WASH STATE
SPACE HTRS STA APP (/.HP MAX) 50 LICENSE NO
MOTORS OVER NOT OVER H P DISTRICT NO G P Z f1E P OC S ED B
�- O 1 J 100 r l�t3 0 C
1 3 15O INSPECTION RECORD
3 8 200
8 15 250
15 50 300
t
SO 100 500
SIGNS NO TRANS L
NO LAMPS
f
SERVICE O 600V NOT OVER 200A 100
L
t
SERVICE O 600V OVER 200 A 200
SERVICE OVER 600V 500
MISC
PERMIT ISSUING FEE 200
SUPPLEMENTARY PERMIT ISSUING FEE too >p L - 3 C
TOTAL FEE $
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE INSPECTOR 8 SIGNATURE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING WIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR 7 T 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE Ai PR .9RTY POWER
SIGNATURE UTILITY CO NOTIFIED n
OF PERMITTEE FINAL
VALIDATI ARTHUR C VEIT
CK MO CA6H SUPERVISING ELECTRICAL ENGINEER
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