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DOSSA
9 55 APPLICATION PLICATION FOR ELECTRIC PERMIT
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DBS
DIVISION OF BUILDING AND SAFETY
Deportment of County Engmeer
County of Los Angeles BUILDING
WM J FOX COUNTY ENGINEER ADDRESS --
CASSATT D GRIFFIN SUP T OF BUILDING
LOCALITY /2
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS STS !TEL
NUMBER EACH FEEOWNERLIGHT OUTLETS
MAIL
RECEPTACLES ADDRESS
WALLSWITCHES
TOTALOUTLETS 5¢ $ ` CITY NO
ELEC RANGES 25 ZS ELECTRICIAN
�f_
_ELEC " - ,.P/L 25 ADDRESS
KW EA CITY TEL NO
FIXTURES 5 LICENSE NO
NUMBER OF LIGHT CIRCUITS DISTRICT NO GROUP ZONE I READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I / I ��
MOTORS l�
NUMBER HORSEPOWER FEE INSPECTION RECORD
NEW MVD HP OVER I INC EACH
1�&LESS $ 25
lb 2 50
2 5 1 00
5 15 1 50
15 50 2 50
50 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
FOR EACH PERMIT
WIRING $1 00 U b
FIXTURES $1 00
SUPPLEMENTARY 50 APPROVALS
TOTAL FEE g 1 SCS DATE INSPECTOR S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT Il
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND10R FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY_AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE POWER I`
DESCRIBED RESIDENT�IAXAOPE TY
SIGNATURE (•'//r'^ UTILITY CO NOTIFIED
OF PERMITTEE FINAL w
WILLIAM J FOX COUNTY ENGINEER VALIDATION A C VEIT CHIEF ELECT INSPECTOR
L> 4 0 5 1- MAR 13 2 1 5 0