51167.1 (2)LOT NO: - ,24
NO. STREET
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z APPLICATION FOR BUILDING PERMIT
� �C[ITY���OF CUPF.RTINO �-� I'J
0 CSanitary No.
W Date SSE 2 `267 , 1.96)2 Permit No. -S—,1/6 7/
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'ta{p',plication is hereby made for a permit to /�.//h-T"
UF UIPFRW
z w a story, Type -If/ Building
aw
a. to be occupied only ain accordance with
0 o Plans, Specifications and Plot -Plan filed herewith. PI Ck Fee
Estimated Value of Improvements, $ Fez E
iJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
* z all other laws applicable to the construction, location, and use of buildings within the City of
0 Cupertino will b complied with. /
3 � Owner - Address !/
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a a By / Address
a0 Phone
Approved, -r-, t I:.r- I 1_11rrrrre H
BUILDING INSPECTOR
State License_.