258 43 .
LOT NO,
NO. STREET
w FOR BUILDING PERMIT
r o OF CUPF.RTINO
S IJSanitary No.
UL 27 1965
i a Uate 196_ Permit No.
0
o Cy4pplic�iQn iUUR� a permit to
< I �f�ii VV ff CU KR
'z m a story,Type Building
< w i
m be occupied only a m accordance with
0 o Plans, Specifications and PI -Plan filed h ewlth. PI Ck Fee
Estimated Value of Improvements, S Fee E °Z
O
J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
Z all other laws applicable to the construction, location, and use of buildings within the City of
o Cupertino ill be complied with
3 �
_ Owner �`J Addr'ss
a a By
O F
< 0Phone Approv
-- — State License—
__ ___ ___B IN INSPECTOR
, �–