NO PERMIT NUMBER (2)• CITY Of
CUPEkTiNO
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Plan Check Division
10300 Torre Avenue
3Cupertino CA 95014
elephone (408) 777-3228
Fax (408) 777-3333
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print): �_ L
TELEPHONE NUMBER:
APN:
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9 263-('1 `::rO
EXISTING ADDRESS: I a 14 B u 9B RD ) CLtPer ,nV C,} IS -04
NEW ADDRESS REQUESTED:1{-
Requests for reassignment of addresses will be approved if consistent with 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
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4. The change in address will not result in a public safety problem.
5. Proof of ownership and picture identification is required.
The fee for change of address is $245.00. The fee is due with this request form and will not be
refunded if request is denied.
The direct costs associated with a request to change_ address will be borne by the applicant.
Approximate review time is fifteen (15) days. If change of address is granted, the new address
will be in effect thirty days following.
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SigntFeDate 06?/
Revised 1/24/00 `"