51064 (2) t�3 16/ a 6kR.e.ec s s�
LOT NO.
NO. STREET
3 �APPH_ CA [ON, FOR BUILDING PERMIT
x o - ® ��I tpry-' OF CUPERTINO
o a tF Sanitary No.
5� (OCT 5 qF ,3'-/d45 s�
i `o Uaie 196_ Permit No.
r
LL w A plication is thereby made for permit to
a In a `+ Of slel),RR 1A
' Building
w
ied on as in accordance with
to be occup
00 Plans, Specifications and Plot-Plan filed herewith. Pl Ck Fee
F ": Estimated Value of Improvements, 5 Fee sZS'O-0
i J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J = all other laws applicable to the construction, location, and use of buildings within the City of
J o Cupertino will be complied with.
i �. ��� C3 19, P t'7 Address /O
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< 0 Phone G 7 �710 S 'l PP
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State License/ Zl BUILDIN INSPEC