1340 (2) j
NO. STREET LOT NO.
;,APPPCIGArT.IM FGR ELECTRICAL PERMIT
Cin FWF CUPERTINO
Date 195— Permit No.
GUKRTIN0 Fee S a C
! (r Application is hefeby 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 ofJhe Electrical Code of the
I'P h City of Cupertino, al/nd all other aws appli e ereto.
y Use of Premises
Own � Address � _� r
By x f'f Address r t
GE �-
CONTRACTOR,:,,AGENT
Approve
C�Phone. `ti Y / 757'7` LECTRIUL ws�pEcroz
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