NO PERMIT NUMBER (2) City of Cupertino
• 10300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF Telephone: (408)777-3228
CU P E kT I NO FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: September 10, 2003
RE: Address Change (APN #357-01-018)
• Please note the following address change: 22291 Janice Avenue has been changed to
22299 Janice Avenue. Please change 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
j City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
. � .� Fax: (408)777-3333
CITY OF
CUPEkT INO
CHANGE OF ADDRESS 03 jJa 00p�
n REQUEST FORM
NAME (please print): R o qe r LOGJ
TELEPHONE NUMBER:
APN: $F 357 — O / —o / R /
EXISTING ADDRESS' 2 2 2 q1 Jay- i Ge - A ✓iv 3•
NEW ADDRESS REQUESTED: 2 2 2 g q Jcj n LQ A✓Q .
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.
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.
2003
Signature Date
Revised 10/16/02
Printed on Recycled Paper
Community Development Department
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
Fax: (408)777-3333
CITY OF
CUPEkTIN®
NEW ADDRESS
ASSIGNMENT FORM
DATE: 6 7 t.5
NAME (please print): — M✓, fe°!�4t_ 1-6 t-
TELEPHONE NUMBER: 4-4- 2r3 -900' �}
APN: # 3�'1 — D l,a T7
I? — 3
NEW ADDRESS: Z zz w 7/r,,j%c,4i A ✓E—.
• The new address will be assigned using the following criteria:
1. The new address will not create confusion.
2. The odd/even addressing system will be maintained.
3. The new address will not result in a public safety hazard.
4. PROOF OF OWNERSHIP and PICTURE ID ARE REQUIRED.
The new address will be in effect thirty(30) days following assignment.
Signature/,w49.1?
Revised 10/16/02
Printed on Recycled Paper
CITY OF CUPERTINO
E� 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # : 23029 PRINT DATE 09/04/2003
PRINT TIME 15 : 39 : 50
RECEIPT DATE : 09/04/2003 OPERATOR counter
COPY # 3
RECEIVED BY counter CASH DRAWER: BS1
REC' D. FROM : CUPERTINO CONST
USER 1
USER 2
NOTES : ADDRESS CHANGE 22291 JANICE
FEE ID AMOUNT THIS RCPT BALANCE
ZADDCHG 245 . 00 ' 245 . 00 0 . 00
-------- -------- --------
TOTALS : 245 . 00 245 . 00 0 . 00
M THOD OF PAYMENT AMOUNT -- . _NUMBER
- ------- - - - -------
CK 245 . 00 4998
TOTAL RECEIPT 245 . 00
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