100048 IDI-1i1;3 " seg
I.OT NO.
NO. STREET
3 APPLICATION FOR BUILDING PERMIT
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Y ° - CITY OF CUPERTINO
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w LL Date o `� 196 ermit No.
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o Application is hereby mad for permit �
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t°be occupied only s aQf�H'i t e with
0 o plans, Specifications and Plot-Plan filed
/herewith. PI Ck Fe
Estimated Value of improvements, 5 �7 Fee$�S.CS.LL�t
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.
3 a . LESToAI E Ld
_ m Owner (Address_
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Address
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a U Phon 2 Z Approve
State Lice BUILDING INSPECTOR '� -
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