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APPLICATION FOR PERMTI!
DEPARTMENT OF BUILDING AND SArEMY
COUNTY OF LOS ANGELES
ELECTRIC
M. J. FOX CHIEF ENGINEER
NAME A DISTRICT NO. G OUP ZpONE PERMIIT NO.
`
K ADDRESS v - Z //0
U CITY TE RECEIVED READY FOR FIRST INSPECTION %A IS$UED�
A COUNTY �P1 6 ']
W CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
DESCRIPTION OF WORK ADDRESS I7w
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS
NEAREST
LIGHT OUTLETS Isw. PLUGS FIXT CR033
CIRCUIT A B C D E F G I H K NAME ( �✓ Y
2 MAIL
3 ADORE98 f.
O
CITY 'In TEL.NO. /
1 AM THE LE AL POSSEgSOR OF THE ABOVE LOS
ANGELES COUN CERTIFLCATE OF QUALIFICATION..
ELECTRICIAN.
I AM THE LEGAL OWNER THE PROPERTY D RIBED
ABOVE d
CORRECtIONS
J
Q
Z
E9
B:
D
TOTAL
NO. OF OUTLETS $ APPROVALS
.NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. S WIRING
NO. OF RANGES-OR HEATERS $ FIXTURES
MISCELLANEOUS S POWER
PERMIT FEE S UTILITYCO.NOTIFIED y�
TOTAL FEE 010 FINAL ���7- `�