1400 (2) NO. 'STREET IAT NO. / .
PST FOR ELECTRICAL PERMIT�
fIMAYf
ryl F CUPERTINO
Date ( ���� 095— Permit No.
Apg��TT�y/ Fee S
' ibn iQl rely RSrfiyty 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 Premi
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v
'a Owne Address
By Address 4 ��/ 1
UCONnGc CTORR,,yAGGE�N/Tr Approved
Phone: �/ it �/`/'L7 Y"' ELECPa[CAL R ECTOZ
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