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18A 663-C EB0611_71 APPLICATION FO ELECTRIQ'AL PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING 3 i0/G/l�,Fj(,TON
BUILDING AND SAFETY DIVISION ADDRESS
LOCALITY /71 lT
NEAREST ^/�rp
FOR APPLICANT TO FILL IN CROSS ST /`' LLJJ
OUTLETS O EACH FEE
5 S OWNER op AN
RECEPT_ MAIL ,../ q
FIRST 20 2S AODRESSJ J /LTD /
LIGHT_ TOTAL ..n /-�
OVER 20 CITY /A/ F/ TEL NO �"
SWITCH_ 10 PLAN CHECK
LIGHTING
TOTAL FIRST 20 ZS APPLICANT
FIXIO
OVER 20 ADDRESS
TURES
RESIDENTIAL APPLIANCES CITY TEL NO
PERMIT
RANGE_DRY ERWTR HTR ,I APPLICANT
STA COOK_DISP _F A U _ ADDRESS
SPACE HTR AIR COND 1 Cl Ty TEL NO
CLOTHES WASH DISHWASH _ LICENSE NO CLASS
FAN—OTHER 100 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STAT! THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
MOTOR! TRANSFORMERS RATING WITH ALL COUNTY ORDINANCES AND !TATE LAW! REGULATING
IND HEATER! ETC HP KW KVA ELECTRICAL WIRING
SIZE B TYPE OVER TO
HEREBY CERTIFY THAT I 1M PROPERLY REGISTERED AMO/OR
0 - 1 IGO LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF Y
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO O
I — 10 300 RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPf RT
^ F V
fFM
TURE / 0
10 - SO SOD RMITTE O
1 so - 100 IDDD r
CT NO CLASS ZONE PROtf l9 By Yj
100 — Soo IS 00 JQF
1
N
SIGN GAS SIGN PND ONE CIRCUIT SOO S r ?
TUBE OR
MARQUEE AppIT10 HAL CIRCUITS 100
SERVI CENOTOVER 600 VOLTS OR 200 AMP 300 l
SERVICE OVER 600 VOLTS OR 200AMP 1000 , APPROVALS DATE INSPECTOR 3 SIGNATURE
POWER POLE
TEMP SERVICE,POLE &APPURTENANCES SDO
SLAB WORK
TEMP LIGHT OR RECEPT SYSTEM 300
CONDIUT
G
ES
AUTHORIZED
PERMIT FEE (SUB TOTALI
Y CO NOTIFIED
PLAN CHECK FEE
PERMIT ISSUING FEE 300
TOTAL FEE
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALID A TI CK M O cASH>
�,D o e , a N Wv 3 0 2 D 6.0 0' Q
,SEE BACK OF APPLICATION FOR COMPLETE SCHEDULE