51117 Oa/ o I e4 LOT NO.
NO. STREET
w APPLICATION FOR BUILDING PERMIT
z �
r � CITY OF CUPERTINO
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o � Samtara No.
5 a
U
i Date 196_ rmit No.ZI // 7
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n . Application is hereby made for a permit to
oa
z in a story,T �+5 Building
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ato be occupied only as in c r a with
0 o Plans, Specifications and Plot-Plan filed here .
Pl Ck F
r "; Estimated Value of Improvements,S Fee$
iJ 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.
3 �
Ow ne ddress
wz
� a By Addres _
<U Phon Approved
"" -" 'State-License-- _--