51145 (3) LOT NO,� +
NO. STREET
W Z g�►P1PL T ON FOR BUILDING PERMIT
a ® �
O I OF CUPERTINO
o Sanitary No, 63�
ILL
Dat c /N0V 16 BARS 196_ Permit No.
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Application is herebymade for a permit to 'sG.ef_GT
z N a CIS 0FStiQPFP-T1N—Q n- /vr 3 ma y) Building
to be occupied only as f�/Gin accordakice with
0 o Plans, Specifications and Plot-Plan filed herewith. PIC Fee
> ; Estimated Value of Improvements, S a4' 000 Fee S ZT-Ia--
i J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
J o Cupertino will be complied with. /J
Owner����-// Address
aBV Ao Address aX'
Phone . S�T�f�C/�p Approved WILLIAM D. BENEVICF{
State License BUILDING INSPECTOR
1