584 (2) LOT NO.
NO. STREET
APPLICATION FOR BUILDING PERMIT
CITY OF CUPERTINO �i
Date 195_ Permit No. V
Application is hereby made for a permit to aA 2r�
1 a story,Type. Building
1�4 at
to be occupied only as
in accordance with Plans, Specifications and Plot-Plan filed herewith.
Estimated Value of Improvements, $ J��G�8'c!ry?I , Fee$�
m
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
a Cupertino will be complied with.
Own '2A �n Address--) Ky.0-c —P
By ! � Address
CONTRACTOR, AGENT
Phone_e�
_ ) Approved 7�cf-Pi
BUILDING INSPECEORa/
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