NO PERMIT NUMBER City of Cupertino
10300 Torre Avenue
CM�F Cupertino,CA 95014-3255
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 10, 2004
RE: Address Change (APN #362-26-003)
Please note the following address change: 1144 S. Stelling Road has changed its address
to 1146 S. Stelling Road. Please change 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
Printed on Recycled Paper
CITY OF CUPERTINO
h1pre 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # : 27652 PRINT DATE 11/03/2004
PRINT TIME 15 : 17 : 58
RECEIPT DATE : 11/03/2004 OPERATOR counter
COPY # 3
RECEIVED BY counter CASH DRAWER: BS1
RECD. FROM MUOI TRINH
USER 1
USER 2
NOTES : ADDRESS CHANGE FROM 1144 S STELLING TO 1146
FEE ID AMOUNTTHIS RCPT BALANCE
- - -- - -- - -------- -- ------- - -------
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TOTALS : 268 . 00 268 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
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--- - - -- --- -- - - - ---- --------
I SCK 268 . 00 3266
TOTAL RECEIPT 268 . 00
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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): GAli
TELEPHONE NUMBER: el-a e .o2S" 7 — L
APN: —00 3,
EXISTING ADDRESS: / / zi 5 0 S 7e-
NEW
-eNEW ADDRESS REQUESTED: / / 6 So S 72/('-'4 c� tic(
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.
I
tgnature Date
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Revised 10/16/02
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