1424 (2) 1�7a6 �-
NO. STREET _ LOT NO,
ELECTRICAL PERMIT
fMAY 18 158Y4[JPERTINo
Date 4 y 1.
' Cily Ur UMMTtUAS� Permit No. �1 Z
UV"Lf�� ��IV Fee S.
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 fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
Use of Premises
Ownerr���� f�w a1 'ti �S Address
� - BY �'�"�''� I
Address �� �
CONTRACTOR, AGENT tl
,G/ ? Approved
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