1239 NO. STREET LOT NO. ;S
A W ELECTRICAL PERMIT
NQ CITY O CUPERTINO
I � 21 9961
Date �n 1 / Permit No.
0F �UP �njl� Fee S O
Application is hereby made to the CiUW 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 Premi
a Owner ee Address
�'• By X/21'/I Address
CONTRACTOR, AGENT Approved f
Imo ,4L--2 "G o C 7 EL CRICAL niSPECr01
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