Loading...
HomeMy WebLinkAbout10090196 Extension RequestCITV OF REQUEST FOR PERMIT EXTENSION Please e-mail the completed form to permitcenter@cupertino.org CUPERTINO M~ Ip. 3 1. -O!> -t>2,0 Q...e.~ \O\bt')b ,O D Under Plan Review Process D Issued Permit Building Address: '2.\ 33b V c'-, t\ve-Permit Number: ____ _ Owner Name: Cw:,, -:s. I'~ ®\.: ". j,)8 \"'-1:,.\--~i\ ('I\~ \"' • a 2,,0 l<\ Owner Address: 1-\330 \J 41 ·, C., f e.t \:b)a Phone: -'='----------- Contact Name: ~' \ ~\t>, l 'o..r:\ , \ r-us.\e.e,, o.N c\._ P Of\ • \ G()(Y\ E-mail Address: "'IC\\~ ~e, ,nr:\-W'-' ff!; y,-'v.ro Phone: U:\O't:>.>92,.. \ -\c, b.S: Reason(s) (please be specific): 3.. c\,s c...,o ~t..:\cc1 ~\'---8\1<,tJ \ "'-M-: \\f>~\hl~ o\- -\s-u.SW ac,;x\ ~01\ cl: e\~,e~\ey c...au..s.o 's. c;l.KY\ \ a... --~ , -=s_ 'C\ee~ \o Signature: ; '"(TG \J>c:ip. Date: 'l I Vo I 'l. li ea.m, :s \f'\.\..tt (CITY OF CUPERTINO USE ONLY) Yes No Approval: D Expired Date: _____ _ Fee:$ ____ _ Revised 7/25/2017 •---__ _,,._.,_ wwa....--.-awwww_.w,.,