51129 (2) LOT NO.
NO. STNEET
W APPC�CA IT ON BUILDING PERMIT
r o CITY OF UPERTINO
p LL
9 i /� �J� 1 2 968 � � Sanitary No.
s u ( J�ILCi/LQi ��
W LL Date 196_ - Permit No. .r//,-2 rf
o ¢ �p
LL w Application isThycreby, e fo}'�
madermi[ton/ / i,lt//K�Ii
oa ••c+t tj1l�I:U
i th a story,Type_ Building
< w
to be occupied only as ,rh,*A4 in accordance with
o 'o Plans, Specifications and Plot-Plan filed herewith. Pl Ck Fee
F ; Estimated Value of Improvements,$ 3�.s-s Fee$ -0G
iJ 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 complied with.
3 �
_ m Ownet Address
W By �// / Address
Phone �'TJr"'I.�[7� t
�U - Approved WILLIAM D. CEfii ES/fCH,
State License BUILDING INSYF.CT00. .�
1