NO PERMIT NUMBER (2) 4 f
City of Cupertino
• �,` 10300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF Telephone: (408)777-3228
CEI�TINO FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: February 16, 2006
RE: Address Change (APN #357-15-002)
• Please note the following address change: 21914 Lomita Ave has been changed. The
new address is 21918 Lomita Avenue. 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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CITY OF CUPERTINO
P• 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 32730 PRINT DATE 01/10/2006
PRINT TIME 09:47:19
RECEIPT DATE 01/10/2006 OPERATOR 8uem
COPY # : 2
RECEIVED BY suem CASH DRAWER: BSI
RECD. FROM FELIX MENDELSON
USER 1
USER 2
NOTES : APPL FOR ADDR CHANGE-21914 LOMITA TO 21916
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
_________________ ------------
CHECK 268.00 271
T& RECEIPT 268.00
.lS/m
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): .2
TELEPHONE NUMBER:
APN:
EXISTING ADDRESS: 21-`Fly G ^4 . T.*�
NEW ADDRESS REQUESTED: Z!9 ! Fl L"-4 rh /}✓E,
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 in a public safety hazard.
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.
ignature Date
Revised 10/16/02
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