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SeSA11 APPLICATION FOR ELECTRIC PERMIT. 1
DI i=w OF BUmmm AND SAFm
Deposimeat of County Saglnaes F:NZAREST
ING .q
County Of T.OS Angeles ESS L
JOHN A.LA BIR.COUNTY ENGINEER �
CASSATT D. GRIFFIN.SUPT OF BUILDING -4�
LITY
FOR APPLICANT TO FILL IN
PST Fs S ST.
NUMBER OWNER
LIGHT OUTLETS 'MAIL
RECEPTACLES ADDRESS 0.01
WALL SWITCHES FEB
CITY TEL.NO. '
TOTAL OUTLETS 0 8¢ $
ELECTRICIAN
ELEC.RANGES 28 ADDRESS
ELEC.HEATERS 28 0
KW EA CITY TEL.NO.
STATE
FIXTURES 8 LICENSE NO.
MOTORS DISTRICT NO. I GROUP I I RSADY FOR IRSPSCf10N
NUMBER HORSEPOWER FfiE
NEW MVD. HP OVER INC. EACH IN�
&I.M.I.M. 8 .28 uTION 0�
.
1 2 .SO
2 8 1 1.00
8 18 1.80
18 80 2.80
SO 200 8.00
MISC.
NO.SIGNS NO.TRANS.
NO.SIGNS NO. LAMPS
FOR EACH PERMIT:
WIRING $1.00 O d
FIXTURES
SUPPLEMENTARY .80
TOTAL FEE APPRoy=
DATE INSPECTOR'S SIGNATURE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP KATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING :: WIRING
ELECTRICAL WIRING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE POWER
DESCRIBED RESIDENTIAL P11,9PERTY,
SIGNATURE UTILITY CO.NOTIFIED I
n
OF PERMITTEE FINAL
JOHN A.LAMBIE.COUNTY ENGINEER VAMAXWXg ARTHUR C.VEIT.CHIEF ELECT.INSPECTOR
CK NO Qct%--,
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