51039PT6I.0T NO.
NO. STREET
W Z ,. PPL•1Q TION, FOR BUILDING PERMIT
° " Fh— d rUPF.RTINO
o¢ Sanitary No.
W 0 wy 31 1968 ij�
_ U. Date 19 _ ermit No. .s—
/4 49
r O
o Applicla`to%llist4anlot-Plan
ader�q a rmit to
a
z N a� stor~ ,` Building
aW
ato be occupied only a with
0 o Plans, Specifications filed herewith. PI Ck Fee
F3 Estimated Value of Improvements, $�?�� Fee $
-z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
o Cupertino wi 1 e complied with.
3Q �
Owner �. �� ��.rr.^—�t— 'Z Address U 4��°'�.
w z f �'
a a By !j! Address
a o
_ U PhoneA Approv
State License UILDING INSPECTOR /