421 /os'3 f
f . � LOT N0. 1_
1 � NO. STREET
APPLICATI, �N� F� _BUILDING PERMIT CrI9�>
h S rF ERTINO
g5_ Permit No.
I Application is hereby made for a permit tct_z
' a / story,Type 1 S;i tlV Building
i ,/
to he occupied only as ✓1�
:t K'} in accordance with Plans;/Specifications and Plot-Plan filed herewith.
•..{ „ Estimated Value of ImprovemMents,a40�_ Fee$
w ` It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
'-1 Cupertipo will be complied wjth.
Owner Address' LCc16
f /
I' s} By Address 9
� CONTRACTOR, AGENT
Phone u' I^!7�f-�s� TApproved
BUILDING INSPECTOR
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