51181 (3)— _�Ii9HL//�/ V /'_ LOT NO. r1t/
rppNOy�j STREET
a� S Il �
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APPLICTION FOR BUILDING PERMIT
AN 9 1968 CiTy OF CUPERTINO S3 �
Sanitary No.
Urate /1!2 % , 1969 Permit No.
A��pp��lication is hereby made for a permit to
arCL_ story, Type rle Building
to be occupied only as in accordance with
Plans, Specifications and Plot -Plan filed herewith. PI Cls Fee
Estimated Value of Improvements, $��%�% . Fee S ��
It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
all other laws applicable to the construction, location, and use of buildings within the City of
Cupertino will be complied with.
Owner
Phone
State License
Address_ M�t _..- •.,c. __ .ra�.....
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Address,_q,r mr. _i A erIi—' cIt:;l.
Approved
BUILDING INSPECTOR
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