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CITY OF CUPL'RTINO
Date t I 95— Permit No. /O
' 00
Fee $ ;W �
�App\/ nn I CpTIn
hcatibnFis herebypbiSYIA tt1'llQ 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 No. of the City of Cupertino.
Owner
�• .Approved
AGENT Am BUILDING INSPECTOR
Building contstructed of or-ex-p—
MATF.RIALS
Condition of extern
Condition of intern
.Present location_
Proposed location4l
Site location on new
No. Street Lot
Block
Tract
NStree[ Lot I
Block
Tract
No. of Rooms
Width .;Z 4/
i
E{ttight_/_ '-�__
City
Other