2679 (2) NO. STREET LOT NO.
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TV 1 R ELECTRICAL PERMIT
0 o R 13 1964c1 F CUPERTINO
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10'-0 Date /� �" 195— Permit No.
CITY OF CUPERTINO Fee S��/s
< Application is hereby made to the City of Cupertino for a permit to install electrical
W I 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
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5 m City of Cupertino, anddaal `Ler laws applicable thereto.
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Use of Pre
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a o �U('i�^ ./Y, 1/ APProved
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