1864 N0. STREET LOT NO.
i
APP TI FOR ELECTRICAL PERMIT
�j' 10F CUPERTINO
W 11p C l2
Date - kl 10 1,863 95— Permit No.
�;, Fee S -p3 D
AppliPa;iifYis GFbyGma(9[RT4 MY of C Cupertino for a permit to install electrical
wiring and/or fixtuyes aslisted-,on-the reverse side hereof, and agrees to install said
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wiring and/or fisfa gs- t ♦ ee.wtkti the provisions of the Electrical Code of the
City of Cupertind'?. pF.411 o` ;laws agjilic a ther o.`
u Use of Prem,
;3 Owner s- - 4 nl) 3 Address /
By "y'f ^ Address
N f co R, AGENT -
/t i•' , ' .Approved
Phone:'-X "�� ��G J:! 4" E&C1RiUC INSPEC71D3t
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