1216 (2) ':z:prt 1
4 f2 LJ f fy Lor No.
NO. STREET
/ 1 FOR BUILDING PERMIT
® C OF CUPERTINO
Date li �l'1 filikk I �v1) C
- 5— e nit No. / I
Application is hereby made for a permit l'1Jto-
a
a MC �oq 25 J� S A 7O Building
at Oto�- Z G t}2 W t t� n1•�F\tJ•Q
to be occupied only as D t k 1 $
in accordance with Plans, Specificitions,and:Plot-Plan filed herewith. 0
y
Estimated Value of Improvements, 0 Fee$ _
� It is hereby agreed that the requirements of aheCupertino Building and Zoning Ordinances and .
all other laws applicable to the onstruction, location, and use of buildings,within the City of
„j Cupertino will be complied with. '
}�ff�
ti Owner � / t/ Address
iBy / Address-
-J CON IACT;RfGENT
' one �1 -� 7_,�� Approved!
Ph
1 BUILDING INSPECTOR
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I, the undersigned do hereby certify that I am
the owner and occa- of Qe single family dwrelling at
b . Y r\ 1 Ct Zw for which I am making .
application to do __ A t�_�y wmrk is a home o; nek
Fy; L 2 so certify, tl'=at T_ n] el ro We any nor;-liceri=e:k
goontrAtor, braa,ill do this wo."Ityself. \
_71
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