51003 MERRITI— 121lP y�I
LOT NO.
NO. STREET
W APPLICATION FOR BUILDING PERMIT
z �
r o CITY OF CUPERTINO
rc _
o < Sanitary No.
5 J'U, >/ as J 003
i W
Date 196_ Permit No.
Fo 7 .
OApplication is hereby made for a permit to_bIS/4lL
a
r
i a a story,Type A? 30 Building
to be occupied only as Qn�.crt� .tk'i�l• -in accordance with
00 Plans, Specifications and Plot-Plan &d herewith. PI Ck Fee
� "; F-stimated Value of Improvements, $ -?0• CO Fee E ha 41.c '_
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
o Cupertino will be complire'd
3 < Owner A .�w.. , r! �i C(�Y� Address
W Z
a a By Address
02
U Phone k •�•S�- S/0.� APProved
State License BUILDING INSPECTOR