HomeMy Public PortalAbout4944 HALLOWELL AVE_Electrical__ 76A683C- CE806B ,�;7s APPLICA ION FOR ELECTRICAL PERMIT
BUILD AND SAFETY DIVISION
FOR APPLICANT TO FILL IN JOB
ADDRESS
New Residential Bldgs.& Pools EACH NO. FEE
1 &2 Finaily Sq. Ft. l $ — $ d LOCALITY
Multi-family Sq. Ft. — NEAREST
CROSS ST.;
Residential Swimming Pools OWNER OR
FIRM NAME
Outlets: Light, Switch& Receptacle MAIL
ADDRESS
First 20
Additional CITY Tel. No:
PLAN CHECK
Lighting Fixtures APPLICANT
First 20 ADDRESS
Additional
CITY Tel. No.
PERMIT
Fixed Appliances Not Over 1 HP APPLICAN
Range_ Heater_ D.W. ADDRESS ,y /i(1
Oven Dryer W.M.
Top FAU W.H. CITY p(�/'� j/r Tel No_-3yA?-:11A6;Q__
Hood Fan LICENSE OR
REG. NUMBER/ � Cla U
Dlsp. A.C.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
• AND STATE THAT THE ABOVE IS CORRECT AND AGREE•TO COMPLY O
Power Apparatus& Large Appliances WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING H
Size&Type HP, KW, KVA,or KVAR ELECTRICAL WIRING, W V
. O.
Up to 1 Incl. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR N
Z
Over 1 to 10 Incl. LICENSED AS REOVIR ED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL O NER OF THE ABOVE
Over 10 to 50 Incl. DESCRIBED RE D NTIAL PROPERTY.
Over 50 to 100 Incl. PERMITEE
Over 100 SIGNATURE
DISTRICT O fROSSED Y
Services
0.-200 Amp. Under 600 V G`
IN SP ECTO R'S
201 - 1000 Amp. Under 600 V. IR
PPROVALS DATE SIGNATURE
Over 1000 Amp.or Over 600 V
POWER POLE
Temp. Power Pole&Appurtenances SLAB WORK
Sign with One Branch Circuit
Additional Sign Branch Circuits CONDUIT
(Other)
RES Q
AUTHORIZED _
PERMIT FEE (Sub-Total) YCO.NOTIFIED
PLAN CHECKING FEE (One-FourthPermit Fee)PERMIT ISSUING FEE
TOTALFEE o'*-.'-o o (y
PLAN CHECK VALIDATION CK.- M.O CASH PERMIT'VA'L'IDATIO ' CK. M.O. CASH - ,
1' 90 QO o ".P"
J o UY
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