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State License
1541
C TION FOR BUILDING PERMIT
® Io ITY OF CUPF.RTINO ,�.�/s_
Sanitars• No.
L 1 ► 196Z Permit No.
Application is hereby made for a permit
to be occupied only
Building
in accordance with
Plans, Specifications and Plot -Plan filed herewith. PI Ck Fee
Estimated Value of Improvements, $ 'e"M4 01, Fee $ �GI�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
Cupertino will/be complied with. O
Owner l/i/ ' -a'e e- - Address
By ��iii�+��/!/c✓ice/��?! Address
Phone A roved
PP BUILDING INSPECTOR
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