NO PERMIT NUMBER (3) q meg✓
/07 05 MI�JJA L ti'//na LOT NO.
NO. 5 tt�
C" _ CITY OF CUPERTI'NO 1 VAL.S
_Q n�'/APPLICATION FOR BUILDING PERMIT l FEE
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it"U V ' "/S 19 78 Building Per.No.
F � Dates
0 V Sanitary Per.No.
3 V Applicatjon is hereby made for
_a_permit to fiur�il /r-��rlK �a y✓.r,y/
a L st y,Qype d"1'a� Structure
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w to be occupied only as y�tT_A/N/SJ_6 p'L[, in accordance with
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'Z N Plans,Specifications and Plot-Plan filed herewith.
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Estimated Value of Improvements, $
w PI Ck Fee$
O O It is hereby agreed that the requirements of the t
> u, Cupertino Building and Zoning Ordinances and all Fee
3 other laws applicable to the construction,location,and
OZ - use of buildings within the City of Cupertino will be Total Fee$
z complied with.
JO
w Z OWNER PHONE ADDRESS
O F CONTR.OR AGENT DDR 5
PHONE STATE LICENSE BUILDING INSPECTOR
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