100038 I
LOT NO.
NO. STREET
z APPLI ATION F R BUILDING PERMIT
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r u.
o CITY OF CUPF.R'I-INO
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< Sanitary No.
I Date 196_ Permit No.
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App kation is hereby made for a permit to
oa a
z N a st y,Type awlding
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t..be occupied 4h6TCf,wCe with
0 o plans, Specifications and Plot-Plan filed herewith PI Ck F
� ; Estimated Value of Improvements, S�—. Fee$ �� �EE
zJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J z all other laws applicable to th construction, location, and use of buildings within the City of
j_ o Cupertino cgmplid mit
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_ w Own r o "Addressz
a By o Phon_U
State License G INSPECTOR
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