B-2018-1669 Request for Permit Extension,)E --�, yo K - _/ //��
CITY OF
REQUEST FOR PERMIT EXTENSION
Please e-mail the completed form to
III permitcenter@cupertino.org
CUPERTIHO
❑✓ Under Plan Review Process 0 Issued Permit
Building Address: 21669 TERRACE DRIVE Permit Number: B-2018-1669
Owner Name:
Owner Address: 21669 TERRACE DRIVE Phone:
Contact Name: ARAM HENESIAN
E-mail Address: ACE.HENESIAN@COMCAST.NET Phone:
Reason(s) (please be specific):
PERMIT IS EXPIRED WOULD LIKE TO REQUEST AN EXTENSION TO SET INSPECTION
Signature: te: 1 /17/24
(CITY OF CUPERTINO USE ONLY)
Yes No
DO
Approval: ❑ Expired Date: Fee: $ 1 Z I —
Revised 7/25/2017