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LOT NO.
NO. STREET
3 Z AMTION FOR BUILDING PERMIT
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o Samtarr No.
ILL Date .��U1012C _ 6_ Permit No. S7046.s�
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o (Application is hereby made for ermit to
z N a �+ITY� OFstV QIQ, IZ Building
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r to be occupied only as eGCA2(/�
o `o Plans, Specifications and Plot-Plan filed herewitt Pl Ck Fee
Estimated Value of Improvements, $Sz: O4 — Fee$
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
O Cupertino will a complie wit L
3 N Owner iG�` zv Address //24,7T!
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a By Address
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a U Phoneme �4—�/ n 17 State License
prove
BUIL 'G INSPECTOR
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