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DBS..3I°LR9 APPLICATION FOR ELECTRIC PERMIT
D3VISION OF BUILDING AND SAFETY ZEE a
Department of County Engineer !BUILDING /�
Count of LOB Angeles ADDRES
JOHN A. LAM SIE, COUNTY ENGINEER
CABBATT D. GRIFFIN. SUPT OF BUILDING _ LOCALITY
FOR APPLICANT TO FILL IN NEAREST
PERMIT FEES CROSS ST.
NUMBER OWNER
LIGHT OUTLETS MAIL
RECEPTACLES ADDRESS
WALL SWITCHES FEE CITY TEL. NO.
TOTAL OUTLETS Q 5¢ $ dio
ELECTRICIAN 1. /
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 f0
KW EA CITY NO.
STATE
FIXTURES 5 LICENSE NO. (O
MOTORS DIST!_ I¢_T NO. IIGF�OUP I � E READY
FDR INSPECTION.
NUMBER HORSEPOWER FEE .Tl— 5 LS16yn�
NEW 'MVD. HP OVER I INC. EACH
O V2 e LS .25ESS INSPECTION RECORD
f 2 50
2 5 1.00
5 75 1.50
15 50 2.50
50 1 200 1 5.00
MISC: �
NO. SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT:
�~ WIRING $1.00
FIXTURES $1.00
SUPPLEMENTARY •50 APPROVALS
TOTAL FEE $ DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT I A A
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING I -26
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA' OR THAT I AM THE LEGAL OWNER OF THE ABOVE I POWER
DESCRIBED RESIDENTIAL P OPE
SIGNATURE �� �`• UTILITY CO.NOTIFIED (a 4 "S-I 11
OF PERMITTEE
JOHN A.LAMISIE.COUNTY ENGINEERATION ARTHUR C.VEIT,CHIEF ELECT.INSPECTOR
lip K MO CAHM
i 9 A`3e 1 2 7.9 5 In
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