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BLD-2021-1349 Permit extension
Revised 7/25/2017 REQUEST FOR PERMIT EXTENSION Please e-mail the completed form to building@cupertino.org Under Plan Review Process (Up to 90 days (3 mo.) extension) Issued Permit (Up to 180 days (6 mo.) extension) Building Address: ____________________________________ Permit Number: ______________________ Owner Name: _______________________________________________________________________________ Owner Address: ____________________________________ Phone: __________________________________ Contact Name: _______________________________________________________________________________ E-mail Address: ______________________________ Phone: _________________________________________ Reason(s) (please be specific): __________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Signature: ______________________________________ Date: _____________________________________ (CITY OF CUPERTINO USE ONLY) Yes No Approval: Expired Date: ___________________ Fee: $ _______________