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!' NO. STREET ,- LOT NO.
APPLICATION. FOR ELECTRICAL PERMIT
3r ITY OF CUPERTINO
Date rrr���///� ✓� 19�1J Permit No. �a w
a ' Ula l 13 7 Fee Si
Application is hereby made to the City of Cupertino for a permit to install electrical
wiring]and/oafixtVJ�Pft � �the reverse side hereof, and agrees to install said
wiring and/or.fixtures m accor a e with the provisions of the Electrical Code of the
City of Cupertino,' and all otlier laws applicable thereto.
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=':a OwnressaLEMUCAL
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By Addressl'
' CONTRACTOR, AGENT
_. "' " Approved
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