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AP.PLIC'ATIONrFOR�HOUSE MOVING PERMIT
u� u 1
lv CITP! CUPERTINO
AY 17 1961111
Date CI_I.�IY�/ Permit No. -S
o r�
Fee
Application is hereby made to the City of Cupertino for a permit to move the building
described on the reverse side hereof from and to the specified location at the time and date
indicated in actor ante with Ordnance No. of the City of Cupertino.
Owner
"7
CONTRACTOR, AGENT
✓JPhone.l:.C/..ra.�.'.lo..W.�.l...........
Approved /I/1,0 Pr/1
BUILDING INSPECTOR
Building contstructed o i( l" _ No. of Rooms.57
MATERIALS Width
Height
Condition of exteri(
Condition of intern
Present location --/�
No. Street n Lot Block Tract ,) City
Proposed
No. Street 67 Lot Block Tract City
Site location on new
on which building is to
Tax certificate filed Ownership certificate filed ` Fee
Other information