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APPLICATION FOR ELECTRICAt PERMITy
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE,-COUNTY ENGINEER _
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY AE T
NEAREST
FOR APPLICANT TO FILL IN C_ROSS ST. 6:6
NO. EACH FEE
$ $ OWNER Q ll>0
RECEIPT._ MAIL
LIGHT TOTAL
FIRST 20 ,20 ADDRESS ell
SWITCH OVER 20 10 CITY TEL.N0.PLAN CHECK
LIGHTING TOTAL FIRST 20 ,20APPLICANT
FIXTURES } OVER 20 ,10 ADDRESS
RANGE-- DRYER HTR. CITY TEL.NO.
STA. COOK_DISP._F.A.U. CONTRACTOR
SPACE HTR. AIR COND. ADDRESS
CLOTHES WASH._DISHWASH. CITY TEL.NO.
FAN_OTHER 1.00 LICENSE NO. CLASS.
MOTORS.TRANSFORMERS RATING I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
IND. HEATERS, ETC. HP. KW. KVA. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
SIZE & TYPE OVER TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
-ELECTRICAL WIRING.
0 - 1 1.00 1 HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
1 - 10 3.00 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
10 - S0 5.00 i IL
SIGNATURE �
50 - 100 10A0 OF PERMITTEE QWKL-
Z-j
100 - 500 15.00 DISTRFCf NO. G UP ZONE PR C E[j(B47
Cu
SIGN,GAS SIGN AND ONE CIRCUIT 3.00 -3 , 0 ou
TUBE, OR
MARQUEE ADDITIONAL CIRCUITS 1.00 NOTES:
SERVICE NOT OVER 600 VOLTS OR 200 AMP 2.00
SERVICE OVER 600 VOLTS OR 200 AMP S.00
TEMP SERVICE, POLE, &APPURTENANCES 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE
TEMP. POWER POLE
UNDERSLAB WORK
ROUGH CONDUIT
WIRING
PERMIT FEE (SUB TOTAL) FIXTURES
PLAN CHECK FEE (50% PERMIT FEE) POWER AUTHORIZED
PERMIT ISSUING FEE 2.00OUTILITY CO.NOTIFIED tD
SUPPLEMENTARY PERMIT ISSUING FEE 1.00 FINAL
TOTAL FEE JOSEPH C. ROOHAN
SUPERVISING ELECTRICAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH, PERMIT VALIDATION CK. M.O. CASH
4229r---' MAR 25 2 D 4,/00 olI
SEE BACK OF APPLICATION FOR COMPLFTF FEE SCHFOULF