107 APPLICATIONOI�R.HOUSE MOVING PERMIT
��Ri� CIT pX CUPPRTINO
JUN 7 1963
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Date Permit No._
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Application is hereby made to the City of Cupertino for a permit to move the building
described on the reverse side hereof from and to the specified location at the time and date
indicatedinaccordance with Ordnance No. of the City of Cupertino.
OwnerT 6 `an_ x/ o '�
By Approved
CONTRACTOR, AGENT BUILDING INSPECTOR
V> Y
Phone Ya. .z. ...............
Building contstructed of No. of Rooms
MATERIALS Width
Height
Condition of exterior
Condition of interior
Present location
No. Street Lot Block Tract City
Proposed location-1-1-1-1
No. Street Lot Block Tract City
Site location on new lot
Route on which building is to be moved
Tax certificate filed-- Ownership certificate filed__:Fee Deposited
Other information
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