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APPLICATION FOR ELECTRIC PERMIT 1
BUILDING AND SAFETY DIVISION
Department of County Engineer BUILDING _n
County of Los Angeles ADDRESS aC
JOHN A. LAMBIE, COUNTY ENGINEER P /1
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 1-G
FOR APPLICANT TO FILL IN CROSS ST. ` /
PERMIT FEES `
NUMBER _ OWNER 71
LIGHT OUTLETS MOIL 6 a n
ADDRESS .!X
RECEPTACLES N
WALL SWITCHES FEE CITY TEL. NO. /'S
TOTAL OUTLETS ® of S ELECTRI AN
ELEC. RANGES 2a ADDRESS -- -'
ELEC. Iff! _..S 2E CITY _ TEL. NO. �—
KW EA STATE
111TURLSLICENSE.NO.
MOTORS DISTRICT NO. (GROUP VZ
ZO/E I READY FOR INSPECTION
NUMBER HORSEPOWER FEE
NEW MVD. HP OVER INC. EACH
s�a LESS s .25 INSPECTION RECORD
2 a Loo
la a0 2.a0
EO 200 E.00
I MISC.
el
f NO. SIGNS NO.TRANS.
NO. SIGNS NO. LAMPS
FOR EACH PERMIT: /
WIRING PERMIT 81.00 L6 0 +.i(Ar/��`"� I :ta��.,Y �j r`✓S�
FIXTURE PERMIT $1.00-1
7
SUPPLEMENTARY .EO APPROVALS
TOTAL FEE ! / DATE INSPECTORS SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CONDUIT
I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WIRING
ELECTRICAL WIRING. FIXTURES -f
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF POWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED + ee
SIGNATURE
OF PERMITTEE FINAL
JOHN A. LAMBIE. 3rALIDATION ARTHUR C. VEIT.
COUNTY ENGINEER C MO CA9H SUPERVISING ELECTRICAL ENGINEER
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