51133 (3) / LOT NO. '
NO. STREET
w APPLICATION FOR BUILDING PERMIT
r o Wa TY OF CUPERTINO
o a FPO,
Sanitary No.
O U; 196_ Permit No.o _ �,q
o W Application is hereby made for a permit to a��� x �� f-6-�
z to a 51 ..L Building
< w J
i ? to be occupied only a in accordance with
0 o Plans, Specifications and Plot-Plan filed herewt h. P1 Ck Fee —
> Hou oea
t- 3: Estimated Value of Improvements, Sc510.00 — Fee S /e
z 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
d O Cupertino wi co tpl' d wh. A
< `fir
_ N Owner - Address
wz
W a By Addres a
0 i
u Phone 2 51- nG 12 APprov
State Licens BUILDING INSYF.CTOR /
t_