540 / ?JAN
St r eI Lot No.
APl IATION FOR BUILDING PERMIT
1. 3 1969 City of Cupertino /
Sanitary No.
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Date , 196 1'er o.
E E �Ppii fhti is h r�vc ar`cl5�n�•�� mit to —r
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to be occupied on'.. accordance with
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o °.i Plans,Specifications and P -Plan filed herewith. PI Ck Fee
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Estimated Value of Improvements,$ Fee
o It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
'> o all other laws applicable to the construction, location, and use of buildings within the City of
o A Cupertino will be complied with.
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e 2 Owner &AeAl/O Ii T 9 40A?I[ Address
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tl E Phone 7�– yz Y L Approve
}�UState License %2 / Y d'u wilding Inspector
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