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2904 (4)
TIr-m.q&ADDITIONAL CHARGE Or CUPERTINO 1964IJ B � 1. G INSPECTOR'S OFFICE. Date ......... . .... ---- ---- .............. 19-.. Permit No. . �x ToCl T-)(. PEMR.'..zz-�- i ...................... ........... ......................... Address e—c,� .................. ......--................. .... ................... ................ ................ Reason ............. .. ...... ........... .. -............................. ------ ........— ....................... .... .................. . .............................................. ............................. ..................... ..................... ............................................ ............................. ............. .4mount$ . ... ..V�"/59-300....... ...... Signed ..... B 4 � y GA ; �c .o O rm � � O .> / g . $ z \ & , f + - n § � / � ] ] � } � C) ■ E / ƒ \ ( � . \/ .