2678 // 0 NO. 'STREET LOT NO. /
g R ELECTRICAL PERMIT
G ` D/ PR 13 196401` F CUPERTINO
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L o Date , 195— Permit No.
° < CITY OF CUPERTINO Fee s
a m Application is hereby made to the City of Cupertino for a permit to install electrical
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r wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
0 o wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
5 a City of Cupertino, and— of cc 1pws applicable thereto.
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Use of Premises
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0 w n 1g, Address
W W By`.''.1...G�-r.�� Z Address
CONT)rACTOR, AGENT o
a U ✓`- C�Y/ Y APProved
Phone: � ELECTRICAL INS►EC700. lb
State License: /0 C `�
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