123 APPLICATION FOR HOUSE MOVING PERMIT
CITY OF CUPERTINO
®
Date O 5_ Permit No. /r�-3
Feed oto ' o
. i tic@I s h rRT4o HY City of Cupertino for a permit to move the building
r\; described on the reverse side hereof from and to the specified location at the time and date
indicated in accordance with Ordnance No. _of the City of Cupertino.
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Owner r
pi
g d App
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tq CONTRACTORS AGHi BUILDING INSPHC70A
Ph-one
Building conestructed of No. of Rooms 3
MATERIALS Widt�f
Heigh
Condition of exterior
Condition of interior
Present location��
No. Street t lock Tract City
Proposed locatioL`(
No. Street Lot Block Tract City
Site location on new lot
Route on which building is to be move S' S .
oz "�
Tax certificate filed Ownership'mrtificate filed_ Fee Deposited—
Other
epositedOther informatio
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TO DEPARTMENT
RECEIPT
• CITY OF CUP ERTINO •
COLLECTORS OFFICE
• No.008071 •
' ..DATE' �_ I '•
RECEIVED ,e �!�
FROM
1.
• ADDRESS I BG a- R •
• "SN I CKECK 'RDFT I •
oKUER DOLLARS CENTS
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