NO PERMIT NUMBER (2) 10300 Torre Avenue
Cit:v of Cupertino,CA 95014
~upertino Building Division
(408)777-3228
(408)777-3333 (fax)
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
CITY OF CUPERTINO
To: All Agencies and Developmental contacts
From: Building Department, City of Cupertino
Subject: APN 362—21 - 036
Date: November 18, 1997
The following address, 1114 Derbyshire Drive has been changed.
The new address: 1116 Derbyshire Drive
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The new address will be in effect thirty (30) days from date of this notice.
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk
mailed to agencies 11/18/97
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Printed on Recycled Paper
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City of,
Cupertino
CHANGE OF ADDRESS
REQUEST FORM/
NAME (please print):
TELEPHONE NUMBER: 4060 7-Z4--113
APN: ^6'22G
EXISTING ADDRESS: / l I SF Debvsk r e r/✓ yt!" 0
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NEW ADDRESS REQUESTED:_f/l �o bV<ky Y/v P,.c aeyt�n a
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.
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 $126.00 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 f!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.
7
Signature Date
win/addreq
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