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• NO. STREET LOT NO.
• D R ELECTRICAL PERMIT
tMAY 6 �60 F CUPERTINO
Date S , 195.Lv Permit No.
CITY OFAUPERTINO Fee s /�
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 Premise<
c i
a Owner �Q'+M�/`�T�'� /�'�� Address
By Address PO --Pox 414
CONTRACTOR, AGENT
/}L o7 —/o o u Approved
Phone: ELECTRICAL INSPECTOR
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