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` ® APPL FOR BUILDING PERMIT
r ° /A(JG 25 OF CUPERTINO
5 a �—, `�� Sanitary No. !!
pxW LL UA1F 196 Permit No:
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01
Application is here y m a permit
i a story, pe� Building
< w
? to be occupied on in accordance with
0 o Plans, Specifications and Plot-Plan file he with PI Ck Fee do
3: .Estimated Value of Improvements, Fee.$, L
oa
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* i all other laws applicable to the construction, location, and use of buildings within the City of
j o Cupertino will be complied with.
' Own d Address
N
a B ti S Address C� • �•
< oPhone o 3' - 3 'S'
U Approv
State Licens �Q �Cs3 u LUG INSPECTOR 4_�