NO PERMIT NUMBER (2) City of Cupertino
• �- 10300 Torre Avenue
CITY()F Cupertino,CA 95014-3255
Telephone: (408)777-3228
CUPEkTINO
FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: May 14, 2003
• RE: Address Change (APN #326-03-015)
Please note the following address change: A separate unit was added to 22059 Caroline
Drive, Cupertino. The main house will remain 22059 Caroline Drive and the new unit
will be 22059 # 2 Caroline Drive.
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
I
Printed on Recycled Paper
Community Development Department
•^ G City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
• MAY 0 1 2003 Fax. (408)777-3333
CITY OF
CUPE1\1IN® BY:
CHANGE OF ADDRESS
REQUEST FORM
NAME (please print): la l:E G-f3 Z Z I✓t u 1 ti D I
TELEPHONE NUMBER: Ji D<T ! 7 3 t5 -7 6 9 PL
APN:
EXISTING ADDRESS: 9-Q 0 5 G P R o Ll WE D 1R , (l l 6, i (.P cls 0 1 'f
NEW ADDRESS REQUESTED: \Le \\
o?aosq-*-0�
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. D
Pa 11V i i 'o43
5. PROOF OF OWNERSHIP and PICTURE ID ARE REQUIRED..
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.
IC3
. Signature Date
Revised 10/16/02
Printed on Recycled Paper
CITY OF CUPERTINO
toe 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 21752 PRINT DATE 05/01/2003
PRINT TIME 14 : 33 : 03
RECEIPT DATE 05/01/2003 OPERATOR counter
COPY # 3
RECEIVED BY counter CASH DRAWER: BS1
REC' D. FROM REGBE ZEWELDI
USER 1
USER 2
NOTES : ADDRESS CHANGE 22059 CAROLINE
FEE ID AMOUNT THIS RCPT BALANCE
-------- - - -- - - -- ------- -- --------
ZADDCHG 245 . 00 245 . 00 0 . 00
-------- -------- --------
TOTALS : 245 . 00 245 . 00 0 . 00
MT' OD OF PAYMENT AMOUNT NUMBER
----- - - - - ---- -------- ----------
CHECK 245 . 00 0467
TOTAL RECEIPT 245 . 00
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