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76A663-CE8p6 10,74 APPLICATIO LE"CAL PERMIT
COUNTY OF LOS ANGELES /
DEPARTMENT OF COUNTY ENGINEER ADDRESS 572,5-a A/1SS14_ 2Q
BUILDING AND SAFETY DIVISION
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST, fR/ iPk/rt.4lf— ,p TQC
OUTLETS N0. EACH FEEOWNER OR
$ RM NAME (r/llff S-S, ��/✓///1
$
RECEPT._ MAIL
LIGHT_ TOT L
FIRST 20 5 U ADDRESS
OVER 20 CITY ,`�;� /dl t -C e'r-� TEL. NO.,q
SWITCH_ .10 PLAN CHECK
LIGHTINGTOTAL FIRST 20 APPLICANT
FIXTURES 10
OVER 20 ADDRESS
RESIDENTI L APPLIANCES CITY TEL. N0.
PERMIT
RANGE DRYER_WTR, HTR._ APPLICANT
STA. COOK DISP. F.A.U. ADDRESS
SPACE HTR. AIR COND. CITY TE
CLOTHES WASH. 01SHWASH. LICENSE OR
REG. NUMBER CLASS.
FAN OTHER 1.00 1 HEREBY ACK44dWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
MOTORS, TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IND. HEATERS, ETC. HP. KW, KVA. ELECTRICAL WIRING.
SIZE & TYPE OVER TO
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
0 - 1 100 LICENSED AS RED IRED BY LOS ANGELES COUNTY AND STATE OF r
CALIFORNIA OR THAII AM THE LEGAL OWNER OF THE ABOVE CL.
1 - 10 3.00 DESCRIPED RESIDENTIAL PROPERTY. U
PERMITEE
10 - 50 5.001 1 SIGNATURE F_
50 - 100 10.00 C.
DISTRICT NO. ROC SED B Cl-
100 - 500 15.00 D G'� Z
SIGN, GAS SIGN AND ONE CIRCUIT 5.00 APPROVALS CJ DATE INSPECTO ' SIGNATURE
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 TEMP. POWER POLE
SERVICE NOTOVER 600 VOLTS OR 200 AMP 3.00 UNDERSLAB WORK
SERVI CE OVER 600 VOLTS OR 200 AMP 10.00. ROUGH CONDUIT
TEMP SERVICE, POLE, &APPURTENANCES 5.00 WIRING
TEMP LIGHT OR RECEPT. SYSTEM 3.00 FIXTURES C
POWER AUTHORIZED
UTILITY CO. NOTIFIED _
FINAL 4^ X / rd
PERMIT FEE (SUB TOTAL) NOTES.
PLAN CHECK FEE
PERMIT ISSUING FEE 3.00
TOTAL FEE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH
0 0 3-Fsno 30 2 0 �
SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE /"�\�