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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ELECTRIC
WM. J. FOX CHIEF ENGINEER
DISTRICT NO. GROUP ZONE PERMIT NO.
Z NAME a�
U ADDRESS
RECEJVVVFP BY READY FOR DATE ISSUED
U CITY �- TEL.NO. {�_ FIRST INSPECTION �� _
J COUNTY3
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 lsw. PLUGS FliT CROSS ST.
CIRCUIT A B C D E F G H m NAME
Z MAIL
3 ADDRESS
O
CITY TEL.NO.
+ 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION..
ELECTRICIAN.
AI AM
BO B THE L"AL OWNER OF THE PROPERTY DESCRIBED
OWNER.
CORRECTIONS
J
— Q
_Z
m
O
r -
TOTAL
Ll 1 2-
NO. OF OUTLETS $ j APPROVALS
NO. OF FIXTURES $ I' 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