455 LOT NO.-
STREET
vO.STREET
w 2 APPLICATION FOR BUILDING PERMIT
sM
r O CITY OF CUPERTINO
Q LL
0 J Sanitary No.
5 a
i LL ll:rte —, 196_ Permit No
S5
ro
o a Application is hereby made for a mit to M N
'z a story,Ty a Building
aw
ato be occupied only as in accordance with
00 Plans, Specification nd Plot-Plan filed herewith. PI Ck Fee
Estimated Value of Improvements, $,/a O Fee E
zJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J z all other laws applicable to the construction, location, and use of buildings within the City of
J o Cupertino will b ye c�mtplied with.
3 Owne _,.� '.�G/ *G Addr ss
w z
i By _ Addres
io
Approved
State License u G INSPE.Ca'OR