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NO. �T LOT NO.
PLICATION ELECTRICAL PERMIT
OCT 19 196b CUPER-riNO`
Date CITY OF CUP Permit No. l /" c>
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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
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(jJ City of Cupertino, and all other laws applicable thereto.
Use of Premie< � ,j
Ow ne f Q Addressmoqlt ��
BY AddressON- 7Q 7� Approved
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