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NO. STREET s LOT NO. .
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APPL'IC MbWFOR ELECTRICAL PERMIT
fes! GI OF CUPERTINO
Date 1-1—Kvl,y�3 Permit No.
Vi i I JC l Uf'L1( P" 4 Fee S /2
Application is hereby made to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
to wiring and/or fixtures in accordance with the provisions of%the Electrical Code of the
<) City of Cupertino, and all other ,1laws applicable thereto.
„ Use'of Premia 1 e Z-d��c o
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Owner Address 6
Q By — C Address SU
CONTRACTOR, AGENT
/ Approved
^ Phone: 1.6 — ^T ELECrEIUL INSPECTOR
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