1423 (2) I` 7V- LOT NO.
NO. STREET '
APPLICATION FOR ELECTRICAL PERMIT
® OF CUPERTINO
Dat /� 199 Z� Permit No. / t
/ Fee 5 _
_p(�; � h��,,��{,y,,y., City of Cupertino for a permit to idstall electrical
wir`It and/cO'tixtTlrt3'a M the reverse side hereof, and agrees to install said
N wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
j City of Cupertino, and all other laws applicable thereto.
v Use of Premises
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;.3 Owner Address
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By 'T`"�> h i., i Address *LECTTLICAL
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UCONTRACTOR, AGENT N
OE- 6--jO6� Approved
Phone: 7�
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