514jc6�t� • '1014S
NO. STREET
1 ;-V-' APPLICATION FOR BUILDING PERMIT'
CITY OF CUPERTINO ~
Date_19 Permit No. �
? Application is hereby made for
a story, Type
f
at
Building
to be occupied only as
in accordance with Plans, Specifications and Plot -Plan filed herewith.
1
Estimated Value of Improvements, $ ��'- e --Z) Fee $ate^ Jy
v
� It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other caws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with
�
r..7 Address
•. ByJ ','F/ �•• Address t
(� CONTRACTOR, AGENT
Phonezzo
C �'�Approve
BUILDING INSPECTOR ,
RECORD OF:INSPEdTI N
"APPROVALS
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