10104 (2)NO. 0 EE LOT NO. L-1-0
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PLICAATg�N' ELECTRICAL PERMIT
2'IVWl CUPERTINO
Date narr cTVPER INQ� Permit No.. `.Ar/,
• • Fee 5 116S
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 f"tures� r' c`co0` }a'tWftt i�Y!�b. P'c (s o2` os oft°t Electrical• Cod C'h
City of Cupegrtmo, and all other labs applicable thereto.
Use of Premi
_3 Owner (/II A",V1117 / /rvMM ✓
:? By
Vv1 /�y'�CONTRACTOR, AGENT
Address
Address 3f_;
Approved
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