NO PERMIT NUMBER (3) • �/ City of Cupertino
10300 Torre Avenue
(,fin OF Cupertino,CA 95014-3255
CUPEI�TINO Telephone: (408)777-3228
FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: May 26, 2006
• RE: Address Change (APN #357-03-071)
Please note the following address & street change: 10428 S. Foothill Blvd has been
changed. The new address is 22487 Palm Avenue (see attached map). Please update
your records accordingly.
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
•
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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): C P k n e-
►� l
TELEPHONE NUMBER: Ca°
6�)
3 S"7 - °3 - 0 -7 /
EXISTING ADDRESS:
NEW ADDRESS REQUESTED: ' J 4 �"� l�Ct I n� — �; i��V {i✓ 0, c7S�lJ�
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 M- a public safety hazard.
i
%•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.
Signa a Date
Revised 10/16/02
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CITY OF CUPERTINO
1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 34473 PRINT DATE 05/19/2006
PRINT TIME 09:33:44
RECEIPT DATE 05/19/2006 OPERATOR suem
COPY # 1
RECEIVED BY suem CASH DRAWER: BS1
RECD. FROM DAPHNE LIU
USER 1
USER 2
NOTES
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
RECEIPT 268.00
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