106 APP�ICSATIONgFOR HOUSE MOVING PERMIT
C+IT OF CUPERTINO
Elm 7 1963
Date 2 19y -� Permit No.
CITY OF CUPERTINO Fee $ c>?-4 07)
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 No. of the City of Cupertino.
Owno -77
v Approved
in CONTRACTOR, AGE BUILDING INSPECTOR
11 i Rhone ................................................ '.
Building contstructed of No. of Rooms_
MATERIALS Width
Height
Condition of exterior
Condition of interior
Present location
No. Street Lot Block Tract City
Proposed location
No. Street Lot Block Tract City
Site location on new lot
Route on which building is to be moved
Tax certificate filed Ownership certificate filed Fee Deposited
Other information