1047,--;2 O %'Z 9 I �z 2 t R .l PS
Date
LOT NO.
'.TRICAL PERMIT
TINO
Permit No. b
/ti I r ur uumn I mu Fee $ is
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
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
Use of
Owner
Ey NTRACTOR, AGEN'
ne:
V`—e 6-�e
Address
Address
Approve,
Size Service
Size Service
of
of
Size Service Switch..��.�9..._.Number of Receptacles........_...
Size Sub Feed Conduit..................Number of Fixtures ------------------
Size Sub Feed Wires .................... Ranges ..... 1. // -------- KW..............
Number of Circuits------------------- Oven ------------- KW --------------
Number of Meters ........................ Signs ---------- Transformers
NEW
RPL
FEES
-- - ----
-------------
........
--------
I
---I
-----
- - ---
---------
-------
----.---
-----------
---
Misc.-----------......--------- .................. Dryers ----- -------------------- ------------ I ----- -- I ---------- I --------------
Motors -------------------- HP -------------------- Phase -------------------- Permit Fee $1.00
Motors-------------------- HP ----------------- Phase -------...--------
Motors ------------------ HP ------------------ Phase ---------------- HP Cliarge-------------- -----,S
TOTALFEES 7`s
RECORD OF INS APPROVALS
RoughWiring ------------- ------------------ ---- Fixt ---- ....---- ----
OALE IHSPEC R DATE INSPECTOR
U
Fin Wiring ---- ------- ---------- - --- otors _....` DAT
,q
Final (y i
GAATEYE
INSPECTOq