51037IY$� 1(d 43 1 Be / A; r C F • LOT
NO. STREET
3 = APPLICATION FOR BUILDING PERMIT
<a
M ° CITY OF CUPERTINO
9t J Sanitary No.
..
_ Date _ { r 1968 196 Permit No.a5/ 6 .3 �7
0 "1
a r Application is hereby made for a permit to re 44 • 0
G<V ry �WIeEi�l lr
i m a T •stoty, Type r •—Tn < < IS ��pD r Building
<w
to be occupied only as in accordance with
0 o Plans, Specifications and Plot -Plan filed herewith. P1 Ck Fee !_
Estimated Value of Improvements, S jrov n0 Fee S 6
iJ 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
o Cupertino will b complied with.
3i
— „ Owner Address
W z�j
W B Address //7f(/ 94 YM Dr. 13 J,
`� Phone %✓ J l 2 i6 Approved ��
f� State License 1.5 9'3 K BUILDING INSPECTOR /