ADDRESS CHANGE - 165 YY/ City of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF
C U P E IST I N O Telephone: (408)777-3228
FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: June 26, 2003
RE: Address Change (APN #366-10-132)
Please note the following address change: 1601 De Anza Blvd., suite #101 has been
changed to 1601 De Anza Blvd., suite #165. Please change your records accordingly.
The new address is in effect now. If you have any questions, please call me at (408) 777-
3246.
Sincerely,
Susan Winslow
Administrative clerk
Printed on Recycled Paper
06/12/03 13:34 124087773333 CITY CUPERTINO 0002/002
3 �
Community Development Department
City of Cupertino
10300 Torre Avenue
Telephone: (408)777.3228
Fax: (408)777-3333
CITY OF
CUPEkTINO
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print): Lul,wl! CpfQ. #Z(p
TELEPHONE NUMBER:
APN:
E)C5'MG ADDRESS:
NEW ADDRESS REQUESTED: 1(GOI -De-An --bW3 t 1
Request for address change will be approved only if the change meets the following
criteria:
• 1. The change of address will not create confusion. Please attach a written account
outlining why the change will not cause confusion.
2. Only the LAST DIGIT will be considered.
3. The odd/even addressing system will be maintained.
4. The change of address will not result in a public safety hazard.
5. PROOF OF OWNERSHIP and PICTURE ID ARE REQUIRED. (-T"
,The fee for a change of address request is $245.00. The fee is due with this
request form and will not be refunded if the request is denied.
The direct costs associated with an address request change will be borne by the
applicant. Approximate review time is fifteen(15) days. If the address change is
granted, the new address will be in effect thirty (30) days following approval.
(93
Signature Date
Revised 10/16/02
Printed on Recydod Paget
CITY OF CUPERTINO
F� 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 22238 PRINT DATE : 06/23/2003
PRINT TIME : 15 :41 : 18
RECEIPT DATE 06/23/2003 OPERATOR : conniew
COPY # : 3
RECEIVED BY conniew CASH DRAWER: BS1
REC 'D. FROM LIMAR REALTY GROUP
USER 1
USER 2
NOTES : CHANG ADDRESS FROM 1601 DE ANZA BLVD. 4101 TO #165
FEE ID AMOUNT THIS RCPT BALANCE
-------- -- - ----- - - ------- --------
ZADDCHG 245 . 00 245 . 00 0 . 00
-------- -------- --------
TOTALS : 245 . 00 245 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------- ----- -------- ----------
CHECK 245 . 00 002523
T 0 L RECEIPT 245 . 00
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