101 'NI
IAPPLIrl'i
�A�T�hO `FORHOUSE MOVING PERMIT
CITY dd IIOII'A� CUPERTINO
Um 3 996
Date 19d 3 Permit No. O
CITY OF C P RI INO Fee
Application is hereby made to the City of Cupertino for a permit to move the building
described on the reverse side hereof from and to the specified location at the time and date
indicated in accordance with Ordnance
eNo.
/ of the City of Cupertino.
Owner
ei
c
v BY APprov4;2
r
PhoneCONTRACTOR- AGENT BUILDING INSPECTOR
------------------------------------------- •.
Building contstructed of � � No. of Rooms_
lATERIALS Width
Height
Condition of exterior
Condition of interior
Present location
No. Street Lot Block Tract city
Proposed locati n 1-1
Na. ' Street /It Block Tract
Site location on new lot
Ro fe on wJii�bw_ building is to be mo
Tax certificate filed Ownership certificate filed Pee Deposited
Other information "