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/c3 �ta 7,12v 1T 19cl? PS DR, LOT NO.
NO. STREET
W = AgCA�TF�Q FOR BUILDING PERMIT
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0 Samtary No.
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W 4 Date a — Permit No.
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4 A plication is hereb made for a rmit to t/J n tic e / o cG!J l2.9
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i m a s y, A+�-c.�l /mQ Building
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to be occupied only as in accordance with
00 Plans, Specifications and of-Plan filed here Ith. P1 Ck Fee
": Estimated Value of Improvements, $ Fee$ Z t>o
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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
J_ o Cupertino will be complied with.
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a a By Address
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4(U Phonr Approved WILLIAM D. BENEVICH
State License BUILDING INSPECTOR
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