1091 NO. � - ' ']'AE� � LOT NO. ,
; APPLLCATIO`N -FOWELECTRICAL PERMIT
;y CITY OFi CUPERTINO
Date _ _ 119§0 Permit No. ��
G�' 91
_rtliiltlU
Fee S 13,
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
'airing and/or fixtures in accordance with the provisions of the Electrical Code of the
. City of Cupertino, and all other laws applicable thereto.
se o emi
c
a ; Owner Ad ress ,
By Addr
CONTRACTOR, AGENT
h APProv
PhlxsPBC7bl
iii
04
P. P6 w
F`
0 0
, 5 t
I the undersigned do ,hgrel;y aer*�fy h t I 'am •..
the owner and o ,upcnt of the single family dwelling at '7.: ~ '
/07/,3. G{/ 'for whic" I am making
P
application to do = or '°r• <'
1 Pl aork��as, 2home owner.
I also certify that I will not, hire any nonilicensed
or ,dontractcr, but wi do this trork JV.1
TElaHONE .P1U B M 1 SIGNATURE•
I