278 I , LOT NO.
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APPLIC�4T FOR BUILDING PERMIT
$ ° tOCT 15 1965 OF CUPF.RTINO
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o Sanitary No.
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w Da((�� 0196 Permit No.
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LL Application is hereby made for a permit to L/C.
i to a story,Type .. �� �d / Building
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to be occupied only as �* ' "! - - accordance with
0 o plans, Specifications and Plot-PI n filed here tth. PI Ck Fee
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Estimated Value of Improvements, Ste/6 Fez E Oz
zJ 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
2 o Cupertino will be complied with.
3 Owner ON ��[ /-ARJI6 Address
a a BY Address / "" SAN 70IF
Ph Pone
<� A<3 / Approved
State License BUILDING INSPECTOR
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