550 (2) 070`/3 2 S L vergdi /-ivy, Cup,
No. ,. Street �fr , Lot No.
APPLICATION FOR BUILDING PERMIT
1 r;
i df Cupertino
JAN 3 9 J , ..r, Sanitary No.
Date 19N. cP'7 , 196E
Permit No. Ir d
Application is hereby made fot,a'permit to7Cie;Sd„
U11I ur Uu) 11% 11.1;L
3 ` a story,Type /11tfA� ✓�,(nt/ic a X 8 si9N. Building
m A 9
U to be occupied only as /g ra�iivc/i c in accordance with
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d Plans,Specifications and Plot-Plan filed herewith. PI Ck Fee
T
A h
� s Estimated Value of Improvements,$ .;r.S—d � Fee$
6 o 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
A Cupertino will be complied with.
c
.3 0 Owner d//.✓ "9- ess_
d By Address
a
E, Pho o?S,67 Approve
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State License B nspector