5325 No. STREET
W X cXPPUICATION FOR BUI
° LDING PERMIT
I ' CITY OF CUPE.RTINO I
Y
o i ' III�'1 Sanital}• No. .�3 �S
i ° Dare fDEC G ,�^I U=�196� Permit No.
LLw Applicati is er y_ ade for a permit to
i in a 1�•/ t story,Type . ��� Building
a o
to be occupied only as J!9K /2 #1J�3 in accordance with
a
00 Plans, Specifications and Plot-Plan filed herewith. P1 Ck Fee
Estimated Value of Improvements, S '*100-�') Fee$ ld—f�,
i 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 will be col plied with.
3 Owne WQAddress
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Addres
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a tj Phone Approved
�L State License BUILDING INSPECTOR /
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