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54 APPLICATION FOR ELECTRIC PERMIT ],
Dee IRDIMON OF BUILDING AND SAFFTY-
Deyortmont of County Engfwar ,^.y�/+
Comty DI Los Angel" BUILDING /d d
WM J FOX COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN SUP T of BUILDING
FOR APPLICANT TO FILL IN LOCALITY L�
PERMIT FEES NEAREST
CROSS ST Zgjd
NUM ER EACH FEE
LIGHT OUTLETS OWNER
T
RECEPTACLES MAIL
ADDRESS
WALL SWITCHES
TOTAL OUTLETS sd S CITY T NO
ELec RwNaea 25ELECTRICIAN C .�
ELEC HEATERS 29 ADDRE68
HW EA CITY TEL NO
FIXTURES
LICENSE NO
NUMBER OF LIGHT CIRCUITSDISTRICT NO GROUP ZONE I R¢ADY FOR INSPECTION
NU R R CLIFCIRCUITS
IR U
MOTORS
NUMBER HORSEPOWER FEE INSPECTION RECORD
N WM=D HP INe EwcN / a
or
e L¢¢B s 25
2 s0
2 is 100
_ s Is 1 so
_ 15 ao 250 _
50 200 500
MISC
NO SIGNS NO TRANS
NO SIGNS NO LAMPS
OR EACH PERMIT
WIRING 6100
FIXTURES 21 GO
SUPPLEMENTARY 60
APPROVALS
TOTAL FEE s ® DATE INSPECYOR S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP ICAT CONDUIT '
AND STATE THAT TXE As IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY 0 XCES AND STATE LAMS REGULATING WIRING ..I
ELECTII ICAL WIRING
I HEREBY CERTI AT 1 AN ROPERLY REGISTERE AND/OR FI%TURfiB
LICENSED AS REO D BT LO ELES COUNTY AN ATE OF POWER
CALIFORNIA OR AM E GA WHER OF ABOVE
DESCRIB EO REHI L PROP TY UTI LITY CO NOTIFIED I
SIGNATURE
OF P Tlua FINAL
WILLIAM J FOX,COUNTY ENGINEER VALuM T § 1 7 N JUN 13 2 3.9 0 IR
BY
DEPUTY