952 NO. LOT NO.
FOR ELECTRICAL PERMIT
i JAN
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TT CITY OF CUPERTINO
e OL ^'Q (�K , 195_ Permit No.
Fee S /0 OO
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 Premis-
a Owner 4Ld� 4O. Address
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By Address
C06TRACTOR, AGENT
G Appro�
Phone: Z a ELECTRICAL ECTM/
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