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DBY'5A 12.54 APPLICATION FOR ELECTRIC PERMIT ],
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING �V 02 nj7 ,jp�
WM. J. FOX. COUNTY ENGINEER ADDRESS �✓
CASSATT D. GRIFFIN. SUPT OF BUILDING
FOR APPLICANT TO FILL IN LOCALITY f + I
NEAREST
PERMIT FEES CROSS ST.
FEE
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LIGHT OUTLETS NUMBER EACH OWNER
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
___TOTAL OUTLETS u S Q CITY L TEL. NO.
ELEC. RANGES 25_ _ ELECTRICIAN "►-�,
ELEC. HEATERS 25 ADDRESS
KW EA CITY TEL. NO.
FIXTURES 5 -y. LICENSE NO.
NUMBER OF LIGHT CIRCUITS
DISTRICT NO. I GROUP ZONE READY FOR INSPECTION
NUMBER OF RECEPTACLE CIRCUITS I /� `I
MOTORS J /°�
_NUMBER HORSEPOWER FEE _ INSPECTION RECORD
NEW MVD. HP OVER INC. EACH
_ 1/2&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. k
NO. SIGNS NO. LAMPS . ` `p
FOR EACH PERMIT:
WIRING $1.00_—
FIXTURES 51.00 CT
SUPPLEMENTARY .50 -
S - APPROVALS
TOTAL FEE S DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CONDUIT I
L
NTTE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
AL WIRING.
Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
IA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
D RESIDENTI L P ERTUTILITY CO.NOTIFIED
REM ITTE FINAL
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION 2 2.3 5 n
6C04032� 23
Y i
DEPUTY