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ViOR ELECTRICA�C IT
UN 5 1863 OF CUPERTINO
Dat ') I) , 1955/_3 Permit No.1TY Or CPU I �
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Fee S �
Application is hereby made to the City of Cupertino for a permit to install electrical
7 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.
jUse of Premiseq
a Owner f',� dress
v
i By Address
CONTRACTOR, AGEM
n Approved
Phone: �� �� �d 2 o ELECTRICAL 14116
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