NO PERMIT NUMBER (2) =. City of Cupertino
' 10300 Torre Avenue
CITY OF Cupertino,CA 95014-3255
PEkTI, 1O Telephone: (408)777-3228
�U
r ry FAX: (408)777-3333
BUILDING DEPARTMENT
OFFICIAL NOTIFICATION OF ADDRESS CHANGE
TO: All Agencies
FROM: City of Cupertino
DATE: September 10, 2004
RE: Address Change (APN #366-15-032)
• Please note the following address change: 1563 Poppy Way has been changed to 1565
Poppy Way. 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,
`;4� ��
Susan Winslow
Administrative clerk
Printed on Recycled Paper
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): SERENA S . CHANG
TELEPHONE NUMBER: ( 408 ) 416-8416
APN: Payc-sl Nu,vn6Y : 366- Is- 0-2Z - 00
EXISTING ADDRESS: 1 563 poppy way, CUPERTINO, CA 9501.4
NEW ADDRESS REQUESTED: 1 565 POPPY WAY, CUPERTINO, CA 95014
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.
Signature Date
•
Revised 10/16/02
CITY OF CUPERTINO
6ge 1 of 1 MISCELLANEOUS RECEIPT
RECEIPT # : 26917 PRINT DATE 09/02/2004
PRINT TIME 14 : 00 : 14
RECEIPT DATE : 09/02/2004 OPERATOR conniew
COPY # 5
RECEIVED BY : conniew CASH DRAWER: BS1
RECD. FROM : SERENA CHANG
USER 1
USER 2
NOTES : CHANGE ADDRESS NO. FROM 1563 TO 1565
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 . 00 302
T(ITAL RECEIPT 268 . 00
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