FILE 100,256i 36�
3 s
No. - Street Lot No.
am @F oukillkho CITY OF CUPERTINO
APPLICATION FOR BUILDING PERMIT
1911 Sanitary No.
Q`'_ Watd� '19 _ Permit No. O O
`-° p is i hereby made for a permit to��%
E
story, YPe a/ r Building
U to be occupied only as in accordance with
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Plans, Specifications and Plot-Planfled herewi PI Ck Fee
N �O
m Estimated Value of Improvements, $ Fee $
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It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
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3 all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
3 Owner Address�L�J
By
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E Phone %S' 7 �o5— 3 Z Approve
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State Licenseildin Inspector