439 LOT NO.
NO. STREET
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w = A, CICFOR BUILDING PERMIT
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Y ° 1 - F CUPERTINO
o < Sanitary No.
w Date ' �!" (k7 1367 9ft Permit No.
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4 W Application is hereb�yy in i:to
i° CITY Q� �'� a=
to a ry, y e � Building
to be occupied only as AA'Q/tal M-67 ^ in accordance with
0 o Plans, Specifications and Plot-Plan filed herewith. Pl Ck Fee
Estimated Value of Improvements, $ Fee E
iJ It is hereby agreed that the requirements of the CupertinoBuilding and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
d O Cupertino will be complied with.
3 F
Owner 'QA (100 Pf) Address
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W a. B y<_fM_rL <fh-1f. O Address /S2 4--6h/icJ622c/ ki✓/e�
< 0 Phone3S(e- 2e) IZo A r eq g� r�
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State License �t9 X09 �� e y � o_