51140 z� 701<� ,zw I Iv La 1, e LOT NO.
NO. STREET
W APPLICATION FOR BUILDING PERMIT
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CITY OF CUPFRTINO
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t a Date '1i 10 196—'> Pe it / -0
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01 Application is hereby made for a permit to
Z N a story,Type o2 Building
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to be occupied only as n accord cc with
o_ o Plans, Specifications and Plot-Plan filed herewith. Pl Ck Fee
0N 1� 0--c'> 0 Estimated Value of Improvements, $ ,L- Fee$
i J It is hereby agreed that the requirements of the Cupertino Building and Zoning rdinances and
Z all other laws applicable to the construction, location, and use of buildings wit 'in the City of
0 Cupertino will be mplied w h.
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_ Owner Address
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State License BMTDING INSPECTOR