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16A66S-CE806 8-62 APPLICATION FOR ELECTRICAL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER fNE7AREIGET
NG
BUILDING AND SAFETY DIVISION S
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING TY
FOR APPLICANT TO FILL IN ST.
RECEPT TOTAL NO. EACH FEE
LIGHT
OUTLETS FIRST 20 2tJ$20 $ OWNER /
SWITCH. / a ADDRESS
OVVERER 2AIL
ADD'20 .10
LIGHTING
TOTAL
LIGHTING 1 �.� F1Rsr 20 .20 CITY TEL.NO.
FIXTURES 1 ADD'L1O ELECTRICIAN elJ O C
OVER 20 J /
RANGES CLO.DRYERS WTR.HTRB. 1:00 ADDRESS
GARB.DISP STA.COOK CITY 4fo)'—//1.1
TEL.NO.G /
D AUTO,-WASH. STATE •� 0�.5
SPACE HTRB. BTA.APP.(Y=H.P.MAX.) .50 LICENSE NO.3�7— /
OVER NOT OVER H.P. DIST CT GROUP NE P ESSED BY
O 1 / 1.00
1 8 1.so app g INSP CTION. RECORD
8 //` P let
8 2.00 H.NAj, g — 4-9
8 15 2.50 ,���'10'
15 50 8.00
O_
50 100 5.00 O
U
SIGNSs
mo.TRANS. Ix
NO.LAMPS O
SERVICE 0.600V-NOT OVER 200A 1.00 0
SERVICE 0.600V-OVER 200 A. 2.00 O.
rn
SERVICE OVER 600V 5.00 ?
MISC.
PERMIT ISSUING FEE 2.00
SUPPLEMENTARY PERMIT 168UING FEE 1.00
TOTAL FEE $
lf
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION APPROVALS DATE IM/BRECT 'S BIGNATURB
AND STATIC THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CONDUIT /
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 77
ELECTRICAL WIRING. WIRING ,I.•L�
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED
A8 REQUIRED BY LOS ANGELES COUNTY AND STATE OF FIXTURES
CALIFORNIA OR THAT I AM THE LEGAL OWNER THE
DESCRIBED RESIDENTIAL OPERTY POWER pp
SIGNATURE UTILITY CO.NOTIFIED / dbAlt
OF PERMITT �,(
1NAL /!H �Iv✓e%
VALIDAT ART UDR C. VEIT �
CK MO CASH. SUPERVISING ELECTRICAL ENGINEER
CD3 7 1 8� DEC20 2 D 17.20- -
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