NO PERMIT NUMBER (/QQ City of Cupertino
70300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF Telephone: (408)777-3228
CU P E IST I NO FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: August 24, 2004
RE: Address Change (APN #357-02-049)
Please note the following address change: 10394 Palo Vista Road has been changed to
10398 Palo Vista Road. Please change your records accordingly.
The new address will take effect thirty days from the date of this letter. If you have any
questions, please call me at (408) 777-3246.
Sincerely,
Susan Winslow
Administrative clerk
Printed on Recycled Paper
CITY OF CUPERTINO
I� 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 26722 PRINT DATE : 08/17/2004
PRINT TIME : 16 : 00 : 38
RECEIPT DATE 08/17/2004 OPERATOR : counter
COPY # : 2
RECEIVED BY counter CASH DRAWER: BS1
REC' D. FROM DANIEL/SUSANNO WONG
USER 1
USER 2
NOTES : ADDRESS CHANGE 10394 PALO VIST TO 10398 PALO VISTA
FEE ID AMOUNT THIS. RCPT BALANCE
ZADDCHG 268 . 00 268 . 00 0 . 00
-------- -------- --------
-------- -------- --------
TOTALS : 268 . 00 268 . 00 0 . 00
MF HOD OF PAYMENT AMOUNT -NUMBER
------- - - - - - -----
ChECK 268 . 00 1053
------------
TOTAL RECEIPT 268 . 00
�U7L�
1City of
4n�ppylVCommunity Development Department
/✓may 60�/'// 10:3300 Tone Avenue
Telephone: (408)77I-3228
Fax: (408)777-3333
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print):
TE11THONE NUMBER: r��— - W bA
CQSSOSSQlO Pard
X14). 3S-7 - 12 z — o�f
APN:
EXISTING ADDRESS: /0 3 ?4 ➢/1'� V15TA oA-,� ,
NEW ADDRESS REQUESTED: /0 3 7
Request for address change will be approved only if the change meets the following
criteria:
1. The change of address will not create confusion. i
2. Only the LAST DIGIT will be considered.
i
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 IS REQUIRED. (Ex. property tax bill)
The fee for a change of address request is $268.00. 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 change request will be borne by the
applicant. Appioximate review time is fifteen(15) days. If the address change is
granted, the new address will be in effect thirty (30) days following approval.
Signature' 7 ../ate /
• Revised 10/16/02
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