484 � v • I V• / LOT NO. �T_
NO. _ STREET
ArjrION FOR BUILDING PERMITJS� g J
ITY OF CUPERTINO
fn _ • 195_ rmit No. ___
Application is hereby made for a permi
(� Building
to be occupied only as
in accordance with Plans, Sp cations and Plot-Plan filed herewith.
Estimated Value of Improvements,$ ��/'L�c�f' rflQ Fee$
u 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
Cupertino will be complied with.
v
Owner moi- Address - �' 3
By / Address
CO ACTOR, AGENT
Phone 0 11() Approved le4_00
BUILDING INSPECTOR
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