1776 (2) NQ. STRB LOT NO.
PA R t ELECTRICAL PERMIT
N OV 2 D 196 ` CUPERTINO
Date V r r I V1�VVI LHT1 IItl1V Permit No.
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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.
v Use of Premi«< +� ��i ✓/
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'a Owner 11.nn4,.,a� � tea•+r�-� Address _ 650 e'-1—,-2
14 By Address L. w.. :
CONTRACTOR, AGENT
Approved
Phone: e� - 2•G d G `7 ELECTRICAL itnPECrb1
.i
1177�
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