51075 (2) LOT NO.
NO. STREET
W Z APPLI ATION FOR BUILDING PERMIT
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20 o CITY OF CUPF.RTINO
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Date 9 196 rmit No.a6/0745
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r Application is hereby made for a permit to
a
i m a story,T Building
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' W Ito be occupied only in accordance with
0 o Plans, Specifications and Plot-Plan filed herewith. PI Ck Fe �—
> 3 Estimated Value of Improvements, S 42 ccn Fee E
t i J 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
o Cupertino wil be complied with. 0 8 8 7 L
3 � .— Pw .� Address �+
Owner r
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By - 2J Address
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Phon $r Approved
State License�G' �u LDING INSPECTOR