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APPLICATION FOR ELECTRICPERMIT g
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEERIS
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BUILDING AND SAFETY DIVISION DREssJOHN A. LAMBIE, COUNTY ENGINEER /1CASSATT D. GRIFFIN.SUPT OF BUILDING ALITY (/ '
F
OR APPLICANT TO FILL IN NEAREST �(LB/Z/
PERMT FEES CROSS
OWNER
1 T E M NUMBE EACH FEE MAIL
. $ S ADDR//RECEPT. SW. ,IOG FIXTURES1O CITY TEL.NO.
GES LLO.DRYERS ELECTRICIAyyN��y/��} 112a,
TER HEATERS .50 ADDRESS j�JCJJCE HTRS. DISHWASHERS CITYDISPOSERS AUTO.- . ^ STATE SanSTA.COOttING UNITS .25 `' LICENSE NO.
: ovER inc. H.P. DISTRICTNO. I GROUP Z E I P SSED BY
O— / .25
'i— 2 .50 INSPECTION RECORD
2— 5 1.00
5— 15 L50
15— 50 2.50
50-200 5.00
SIGNS: NO.TRANS.
NO.LAMPS
SERVICE O-BOOV 1.00
SERVICE OVER BOOV 5.00
MISC.
WIRING PERMIT 1.00 60
FIXTURE PERMIT 1.00 !
SUPPLEMENTARY PERMIT .50
TOTAL FEE 3
1 KIO
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP ATN APPROVALS DATE INSPECTOR'S SIGNATURE
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CONDUIT
LEL8�RICAI. WIRING. (? {.
BY CERTIFY THAT I AM PROPERLY REGISTERED pNDIOR WIRING O - �� / �'/AS REQUIRED LOSANGELES COUNTY AND STATE OF FIXTURESIA OR THAT MTNER TH HOYED RESIDENTIA ROPERTY. POWERRE UTI LITYCO.NOTIFIEDMIT!' FINAL �' �7 �IJ ��/��..I�i....,✓I
®n /DATION SUPERVISING ELECTRICALENGINEER
CK MO CASH
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