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DBS 5A 25M SETS 2-47 ,APPLICATION FOR PERMF
DEPARTMENT OF BUILDING AND SAFETY ELECTRIC
COUNTY OF LOS ANGELES
WM. J. FOX CHIEF ENGINEER
DISTR=-NO. GROUP I ZONE PERMIT NO.
NAME
F2 ADDRESS f _
RECEIVED BY READY FOR DATE ISSUED
U CITY TEL.NO. FIRST INSPECTION
J COUNTY c_"�
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 FIZT CROSS ST.
CIRCUIT A B C D E F G H W NAME
Z MAIL
3 ADDRESS
O
CITY TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
I ANI THE I EGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
tOWNERI
CORRECTIONS
a
z
c�
0
TOTAL I
NO. OF OUTLETS 11j
$ APPROVALS
NO. OF FIXTURES $ DATE INSPECTOR'S NAME
NO. OF MOTORS H.P. $ CONDUIT
NO. OF SIGNS TRANS. $ WIRING
NO. OF RANGES OR HEATERS $ FIXTURES
MISCELLANEOUS $ POWER
PERMIT FEE $ UTILITY CO.NOTIFIED
TOTAL FEE FINAL