10104 NO. 0 EE LOT NO. L-1-0
fiPPLICAT'QN' ELECTRICAL PERMIT MAR CIJPERTINO
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Date . _ _ - .TVPERTINQPermit No.. ''.-/,Odd
• • Fee 5 16S
t 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 fi tures r c`co p"i$ (s oC os oiv Electrical-Cod r .
City of Cupegrtmo, and all other labs applicable thereto.
Use of Premises
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'a Owner Address
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CONTRACTOR, AGENT
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