51167.2 LOT NO. (J__�_
NO. STREET
CITY OF CUPERTINO CAP. {
(((vqL. 6 O O
APPLICATION FOR BUILDING PERMIT ` FEE J�
w 5 Building Par.No. S6 .Z
Date
O C� • 19 Sanitary Per.No.
3 Application id hereby made for a permit to Gd ti
�t4J(:cc.J .Buy i
U G
u+ u_ a story, Type Structure
otobe n cupiecl 3 ly A�O f A 7i c C c ✓�2 in accordance with
O F - �/O
Z w Plans,Specifi^^cations and Plot-Plan filed herewith.
.wz- Estimated Vague of Improvements, $(9 0-c)
PI Ck Fee$
O O It is hereby agreed that the requirements of the /�-'C'fe yg(
> w Cupertino Building and Zoning Ordinances and all e $_
aother laws applicable to the construction,location,and
Z use of buildings within the City of Cupertino will be Total Fee$
-' ZO complied ``witth/h--.
3 > Y ( x F66 -2611 w
w w OWNER PHONE ADDRESS
rx a
00 CONTR.OR AGENT vADDRESS� j
PHONE STATE LICENSE BVJLDING INSPECTOR 1,6e