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76A663.CE606.7.56 APPLICATION FOR ELECTRIC PERMIT 1
BUILDING AND SAFETY DIVISION
Department of County Engineer FADDRESS
ING
County of Los Angeles JOHN A. LAMBIE. COUNTY ENGINEERCASSATT D. GRIFFIN, SUP'T OF BUILDING ITY
FOR APPLICANT TO FILL IN Cill"IFTNROSS ST.
PERMIT FEES
NUMBER OWNER E ..-
LIGHT OUTLETS MAIL
ADDRESS
RECEPTACLES -
WALL SWITCHES FEE CITY - TEL. NO.
TOTAL OUTLETS @ 5¢ S ELECTRICIAN
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY �, oAllAel.�� TEL. NO.
KW EA STATE
FIXTURES 5 LICENSE NO.
MOTORS DISTRICT NO. GROUP ZONE READY FOR INSPECTION
NUMBER HORSEPOWER I FEE I /[��
NEW MVD. HP OVER INC. EACH
s /Z&LESS .25 INSPECTION RECORD
�/2 2 .50
2 5 1.00
5 15 "1.50
15 50 2.50
50 200 5:00
misc.
NO. SIGNS NO. TRANS.
-NO. SIGNS NO. LAMPS
FOR EACH PERMIT: '
WIRING PERMIT $1.00 ®�
FIXTURE PERMIT $1.00
SUPPLEMENTARY .501 APPROVALS
TOTAL FEE 1 $ DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CONDUIT
ISTATE THAT H CORRECTE ABOVE IS ALL COUNTYORDINANCESANAGREE COMPLY TO
STATE LAWS REGU AT
WITH NG WIRING
ELECTRICAL WIRING. FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR —
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P F�
UTILITY CO.NOTIFIED -��,�� ;��'��"d�'.:e�,:•�'
SIGNATURE ® a•., /: "q
OF PERMITTEE �'�".,,'�p/�!r -`"-' "'�'� FINAL
JOHN A. LAMBIE. VALIDATION ARTHUR C. VEIT.
COUNTY ENGINEER CK MO CASH SUPERVISING ELECTRICAL ENGINEER
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