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KO. RE LOT NO.
r o ® �PCIC'ATt FOR ELECTRICAL PERMIT
. < !:e 11. 21 1964c1 of cupexTlrao
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o0 Date *' -Ine Ilr�� Permit No.
a Fee
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V) Application is hereby made to the City of Cupertino for a permit fo ifistall electrical
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wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
00 wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
5 City of Cupertino, an other laws applicable thereto.
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Use of Premises t�
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3 < Owner Address
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CIATRACTOR, AGENT
a o �y� Y Approved
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