NO PERMIT NUMBER City of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF Telephone: (408)777-3228
CU P E IST I N O FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: November 21, 2005
is
RE: Address Change (APN #375-40-014)
Please note the following address change: 6161 Shadygrove Drive, Cupertino, CA is
changing its address to 6165 Shadygrove Drive, Cupertino, CA 95014. Please update
your records accordingly.
The new address will take effect immediately. If you have any questions, please call
me at (408) 777-3246.
Sincerely,
Susan Winslow
Administrative clerk
•
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•
CITY OF CUPERTINO
f� 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # : 31573 PRINT DATE : 10/12/2005
PRINT TIME : 12 : 12 : 43
RECEIPT DATE : 10/12/2005 OPERATOR : conniew
COPY # : 3
RECEIVED BY : conniew CASH DRAWER: BS1
RECD. FROM : TAHUL PANDIT
USER 1
USER 2
NOTES : BOB S .
FEE ID AMOUNT THIS RCPT BALANCE
-------- -------- --------- --------
ZADDCHG 268 . 00 268 . 00 0 . 00
-------- -------- --------
-------- -------- --------
TOTALS : 268 . 00 268 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 268 . 00 VISA
'.•AL RECEIPT 268 . 00
•
Community Development Department
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
Fax: (408) 777-3333
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print): R14-H UL • ORM2 =
TELEPHONE NUMBER: 0 " 3 5-/,2O 6
APN:
EXISTING ADDRESS: GI6/ SITYG�oyE l�/2 CU� T'�o- Cf� 9 SJ i lei
NEW ADDRESS REQUESTED: 6/6y YC— 4>2 GvOfiivo, C/�9s®/f<
Request for address change will be approved only if the change meets the following
criteria:
• 1. The change of address will not create 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 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. 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.
• --r
Si tore Date
Revised 10/16/02
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