1773V4 �
NO. STREET ' LOT NO.
1 ELECTRICAL PERMIT
f,UPERTINO
f Nov 2 0 ion
Date
—1195— Permit No.
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aJ t h Of U@`tb thE*� Fee 5
Appliph s- er ma 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 Premises C
Owner -j lz
i
By
CONTRACTOR, AGENT
Phone: k.3 Jew ( 7 -? Z
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Address �
Address Nt `� � G/_`.• -'L
Approved ��/_. –
ECECfEICAL 1NSPECrbi
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