NO PERMIT NUMBER (2) City of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF Telephone: (408)777-3228
CU PE IST I N O FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: March 25, 2005
RE: Address Change (APN #342-14-092)
• Please note the following address change: 10164 Prado Vista Drive has been changed to
10168 Prado Vista Drive. Please update your records accordingly.
The new address will take effect immediately. 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): M M E S TP UAl
TELEPHONE NUMBER: 4 ° 8 — 8 5B —24 o 7
APN: 3¢2 — /4 — 0pi - 0o
EXISTING ADDRESS: 10145-+ pra do V;s l a Dr.
NEW ADDRESS REQUESTED: 10 " b Prado V 1,4a
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 " 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.
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CITY OF CUPERTINO
*ge 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # 28794 PRINT DATE 03/03/2005
PRINT TIME 13 : 17 : 15
RECEIPT DATE 03/03/2005 OPERATOR counter
COPY # 3
RECEIVED BY counter CASH DRAWER: BS1
REC 'D. FROM JAMES TSUNG
USER 1
USER 2
NOTES : CHG ADDRESS FROM 10164 TO 10168 PRADO VISTA DR.
FEE ID AMOUNT THIS RCPT BALANCE
---- - - - - -------- - -------- --------
ZADDCHG 268 . 00 268 . 00 0 . 00
TOTALS : 268 . 00 268 . 00 0 . 00
ETHOD OF PAYMENT AMOUNT NUMBER
-------- - -- ------------ --------- ---------
ECK 268 . 00 116
------------
TOTAL RECEIPT 268 . 00
I •