2783 (3) LOT NO.
NO. Lf SrhaeTj Z f n
® APPLICAT� 111.. OR 13UILDING PERMIT
�NOV 22 1963'c�TY oP CUPERTINO
o a •/ '�'"� Sanitary No.
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wDate 19 Permit No.
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o F Application is hereby made for a permit to
i in a story,TypeS r�T�,�//��✓ �7G� Building
to be occupied only ass
00 in accordance with Plans, Specifications and Plot-Plan filed erewith.
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Estimated Value of Improvements, $ eXi Fee$ 601`'
°z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* Z all other laws applicable to the construction, location, and use of buildings within the City of
2 O Cupertino will be complied with. ��• ,�!!
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a By < iley'r� Address . �
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Approve
State License i9�6oq BUILDING INSPECTOR
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