2567 NO ET LOS NO. /
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0 PL CATION' OR EL'ECTR_ICAL PERMIT
Y
o /JAN 22 19691E CUPERTINO
3u
LL a Date !A,05— Permit No.
0 r Fee S �S
a N Application is hereby made to the City of Cupertino for a permit to install electrical
* I wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
o 'o wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
> City of Cupertino, an other laws applicable thereto.
r
z J Use Of Pyn)ises
J 0
0
3 a Own Addre
N
w w _ Address
LL NTRACTOR, AGENT
< 0 —(4Y/ y/ Approved
Phone: ELECTRICAL IMPECIb1
State License;
44
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