NO PERMIT NUMBER Plan Check Division
q 10300 Torre Avenue
/
Cupertino CA 95014
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3 3elephone(408)777-3228
CITY Of Fax(408)777-3333
CUPEkTINO
CHANGE OF ADDRESS 2�3
REQUEST FORM �
NAME (please print): _. ( L V
TELEPHONE NUMBER: 4 S o2 6 3 - ! ,` C)
APN: �7 y
EXISTING ADDRESS: I bQ 11', B u 91'CB D ) C'tR�nv rh 1-x-04
NEW ADDRESS REQUESTED: oZ I p �I.1Fig � Ctkfe -!'-(It'10 cAls-C511{—
Requests for reassignment of addresses will be approved if consistent with the following 1
criteria:
1. The change of address will not create confusion. &ASC- C-047AC-f
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2. Only the last digit will be considered. C L L L t ��I 0
3. The odd/even addressing system will be maintained. (./mac g _ l 2l g U 0
4. The change in address will not result in a public safety problem. ` l
5. Proof of ownership and picture identification is required.
The fee for change of address is $245.00. 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 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.
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• SignbFreDate 106?/
Revised 1/24/00 Ca