51022-X� / r/,rli c & Dr- I.OT
NO, STREET
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO
5anitarY NO.
q53
Date / —o 1965 Permit No. 1r
Application is hereby made for a permit to
a story, Type _ �_ fJ Building
to be occupied only asPlfY n�mrlance with
Plans, Specifications and Plot -Plan filed herewith. P1 Ck e
Estimated Value of Improvements, S t-.2 Y 4-0 Fee $ >to -jt../ i
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,wi be complied with, p , '
Owner�r-.�,-.1n�G %� �� Address X--%�9 T�%sacc•
By Address
Phone -S� - (o "216 d
State
Approved 4
BUILDING INSPECTOR