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NO. ..eREE'` -
APPLICAT dN FOR BUILDING PERMIT
CITY_OP_CUPERTINO- - - -
Date 7 IO 19�Z rmit No. d
Application is hereby made f r rmit to
¢ � /5
a story,Type" - building
at
t
to be occupied only as -
in accordance with Plans, Specifications and Plot-Phan filed herewi
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Estimated Value of Improvements, Fee$ iU0 IFF
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c II 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.
Owner Addressauo6 ? a�oc�oL
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By � Az>Oct_
CONTRACTOR, AGENT Address 3 dam{.
Phone - �/ Approve
to BUILDING INSPECTOR
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