1781 (2) )0302- I � Lj
,.NO. STREETC7 LOT NO.
C PT= R ELECTRICAL PERMIT
CIWF CUPERTINO
11 +NOV 2 33962 t 7 Q
Date 2Z 0 , 19K Permit No. _ L U
INTY fir Fee S IS—To
Application is hereby made to't[W 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 applicabl ereto.
Use of Premi
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.4 Owner Address
In By . "a Address / 4�
OR, AGENT
i 'r• •— Approv
Phone: 41C f S A- za (ELECTRICAL INSPECrol
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