1023 (3) D k/ f V C , /," 1 I— I, L /9V'0_ LOT No.
NO. STREET `
Uv IIcaie CIU WING PERMIT
TINO
Date � � 1 S 19 Permit No.
Application is hereby made for a germy o
a (2) N G 7 story,Type 1� t 1 o Ce J(L►� Building
at U C� I 1 �� 4:p—
to be occupied only as (� t 1. I t ' O Co if 2 4
in accordance with Plans, Specifications and Plot-Plan filed herewith.
Estimated Value of Improvements, $ Fee$ Z 0,C)
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a It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the c s uction, location, and use of buildings within the City of
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Cupertino will be complie ait `
t�d OC Address 10 1 O 9� KV r �I
Owner
By Address
CONTRACTOR, AGENT
i 1-Phone Approved
tt'I BUILDING INSEECTO�
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