121 APPLICATION FOR HOUSE MOVING PERMIT
CITY OF CUPERTINO
Date 1L3 Permit No.
Fee$
p Application is hereby made to the City of Cupertino for a permit to move the Iuilding
t1 described on the reverse side hereof from an5,tR the specified location at the time and date
n : indicated in accordance with Ordnance No. . f the City of Cupertino.
I
Owner r-
v
cs /j�
$yam/� �i� I /It n . -TM/-- - Approved
CONTRACTOR, AGENT BUILDING INSPECTOR
Building contstructed No. of Rooms—/—
MATERIALS
oomsMATERIALS Width 21-
n Height
Condition of exterior +�r�-<
Condition of interior
Present location —kgroq vis Lw
No. Streets Lot Block Tract City
Proposed location a,,e
No. Street Lot Block Tract City
Site location on new lot
Route on which building is to be movedcc . �— J J -
Tax certificate filed Ownership certificate filed Fee Deposited_
Oth r info a on �o