2454 (2) NO. R R LOT NO.
An
1 I FOR ELECTRICAL PERMIT
OCT 1 11CIF CUPERTINO
Date ply+ L 14 n 1 h 1'I9&3 Permit No.
Fee S
Application is hereby made to the City of Cupertino for a permit to insfall
melectrical
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
O
City of Cupertino, and all other laws applicable thereto.
or
Use of Premi P< ��
a
Ow ne T Address
n By 11rWTINr 9, npi:.,zinn Address
Approved � z t v+ f
Phone: SAN JOSE. CALIFORNIA / ELECTRICAL IMPECE0%
(1., CYpress 5-0644
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