51195r`..n�
NO. STREET
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
Sanitary No.
196, .r
3-4 ermit No.
Application is hereby made fora permit to
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to be occupied only
Plans, Specifications and Plot -Plan d k
Estimated Value of Improvements, $
OO PI Ck Slee —'�-
Fee S
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
Owner Address
14 I
Ad8 s � ' t WC ° 4
Phon1�2[1 Approve
State License B . ING INSPECTOR
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