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APPLICATION FOR HOUSE MOVING PERMIT
CITY OF CUPERTINO
Date J Z� 19�V� Permit No. ZJ 6
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 No. _of the City of Cupertino.
Owner ���7"//!d ���✓
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CONTRACTOR, AGENT - BUILDING INSPECTOR
Phone ------------------------------- ----- -.
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-1-1-1-1
No. Street Lot Block Tract City
Site location on new to
1-16
Route on which building is to be moved
Tax cer tfica a led Ownership certificate fi ed Fee Deposited
Other information