NO PERMIT NUMBER jr f7 S►. AD R ",.' LOT NO. 6 9
NO. STREET 6'
CITY OF CUPERTINOCAP .(vgL.7`r 0� s
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d APPLICATION FOR-BUILDING� PERMIT PEE�.2-5-
0 (9/� ,'-i:tiC30 r 19 L_,G_ Building Per.No. y/4 _
Date
Sanitary Per.No._66 0 7 3
O a AppliEatiof is hereby made for a permit toCd N ST PL 'y .2-,8
_ a P sto�ry,'Tyn/HR.2.218 64i� �. Sa� Gx12 Structure
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O a to be occupied only;"_? e1 "T 5 /tV CI` - FK3wt d GR2in accordance with
Z w Plans,Specifications and Plot-Plan filed herewith.
a w t•
Estimated Value of Improvements,$7;�-/f--" "
LL PI Ck Fee$
O O It is hereby agreed that the requirements of the-,` '. - �37 6-0vi Cupertino Building and Zoning Ordinances and"all Fee$
p a other laws applicable to the construction,location,and
Z use of buildings within the City of Cupertino will be Total Fee$
ZO complied with.
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iOWNER PHONE ` w ADDRESS /'i
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Q O CONTR.OR AGENT AD RESS
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PHONE STATE LICENSE IL P
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