51039 fSlj/o 3.l0 o I o05�/fR L S�,o f�P�yE
LOT NO.
NO. STREET
W nA1PPr CATION FOR BUILDING PERMIT
Y o CITY OF CUPERTINO .j(6
LL
2 _
o J
AN 11 19 Samtnn No.
SU
w Uarc 196_ /� Permit No.
~ oItt1Fion i 6 permit to
01
CIYaf p �t tJt7S #�T �10r a
i N a story,Type Building
w ; to be occupied only as in accordance with
0 o Plans, Specifications and Plot-PI n'filed herewith. P1 Ck Fee —3
Estimated Value of Improvements,5 d 3,D o 0 iL—v Fee$ 7a
i J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* Z all other laws applicable to the construction, location, and use of buildings within the City of
J O Cupertino will be complied with.
NOwner n Addre[sss>s-i7g i!�!�>,;uc'��S,i4 y
¢ a By X Addrt7 a�f/
O F
U Phone "�y�Ds ? . Approve
State License Z BUILDING INSPECTOR
1
J