2058 S ET LOT NO.
ELECTRICAL PLiAli'IJUN5196JIIR
F CUPERTINO
Date UAL� UP 1 IIFIt_ 'A-3 . Perm t No.
rr «„ Fee $
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 Premi
xrn'a Owner 4•k,-� �h�• "�. Et- *��� �,Address
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By Address
u1 CONTMCTOa, AGEM
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Phone: o/a �a�.2�
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