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SDEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR P�RMIT
COUNTY OF LOS ANGELES ]ELECTRIC
WM J FOX CHIEF ENGINEER
NAME Wr��79I�e'' �tc'� . ��/ 6y :� DISTRICT NO GROUP ZONE PERMIT NO
ADDRESS L2 24 �¢1�,c� LJ/y g) (�
CITY MJ1I) TEL NO f '�'�� REC� ED BY FIRST INSPECTION READY FOR DATE ISSUED
COUNTYCERT NO 6.2- EXPIRES (1-1 f
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY —/0
DESCRIPTION OF WORK AODREss �Aa,.c��
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS
NE4REST
LIGHT OUTLETS SW' PLUGS I FIXT CROSS ST
CIRCUIT A B C D E F G IH I E NAME 61/a-, /f ju.rS,t�crL�
Z MAIL
3 ADDRESS
O
CITY TEL NO
I AM THE LE6 POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFIC TB O UALIFI ATION
ELECTRICIAN
I AM THS LEGAL OWNER OP 6 PROPERTY DESCRIBED
ABOVE
OWNER
' CORRECTIONS
J
— a
z
0
0
TOTAL
NO OF OUTLETS $ APPROVALS
1 NO OF FIXTURES $ DATE INSPECTOR S NAME
NO OF MOTORS,,-7 a HP , $ CONDUIT
NO OF SIGNS TRANS $ WIRING
NO OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
r�
PERMIT FEE $ UTILITYCO NOTIFIED
TOTAL FEE _ �fJ FINAL1