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lv 0 3dc3 I �7' LOT NO, 13
NO..0 i75TRE2T
APPL'IC TION -FOR BUILDING PERMIT
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= p ' t1 _CITY jOF CUPERTINO �.
p < fAPR 9 iSf$ Sanitary No.
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_ Untr 196_ ermit No.
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o < Application is herc6yjmCd"forja�permit to
z In a 0—story,Ty I Building
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to be occupied onl in accordance with
o 'o Plans, Specifications41'ements,
lot-Plan filed her Ith. PI Ck Fee \'f_0..?S
Estimated Velue of 1 $ Fee$ Q D�o� MCI
zJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
Z all other laws applicable to the
_ constniction, location, and use of buildings within the City of
< Cupertino wmlied with.
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Ownevlls� vAddress�(n / at-
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a a By x �a ( ctsa �,. �l Address.. <q
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State License B DING INSPECTOR /
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