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DEPARTMENT OF BUILDING AND SAFETY APPLICATIOIlT FOR PERMIT
COUNTY OF LOS ANGELES ELECTRIC
WM. J. FOX CHIEF ENGINEER
Q NAME / DISTRICT NO. GROUP I ZONE PERMIT
/NO.
ADDRESS
RECEIVED BY READY FOR DATE ISSUED
U CITY TEL.NO. FIRST INSPECTION
J COUNTY i r
W CERT.NO. EXPIRES
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
.DESCRIPTION OF WORK ADDRESS .�� .
NUMBER OF OUTLETS ON CIRCUITS LOCALITY
LOCATION BY ROOMS NEAREST
LIGHT OUTLETS SW. PLUGS FI%T CROSS ST.
CIRCUIT A B C D I E F G H K _NAME
Z MAIL d
3 ADDRESS
O
CITY TEL.NO.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
OWNER.
CORRECTIONS
J
Q
Z
O
TOTAL
NO. OF OUTLETS $ APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING f- '
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ UTILITY CO.NOTIFIED
TOTAL FE FINAL