BLD-2021-01820 Extension Request Revised 7/25/2017
REQUEST FOR PERMIT EXTENSION
Please e-mail the completed form to
permitcenter@cupertino.org
Under Plan Review Process Issued Permit
Building Address: ____________________________________ Permit Number: _______________
Owner Name: ________________________________________________________________________
Owner Address: ____________________________________ Phone: __________________________
Contact Name: _______________________________________________________________________
E-mail Address: ______________________________ Phone: _________________________________
Reason(s) (please be specific): __________________________________________________________
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Signature: __________________________________ Date: _________________________________
(CITY OF CUPERTINO USE ONLY)
Yes No
Approval: Expired Date: ___________________ Fee: $ _______________
21985 McClellan Rd BLD-2021-01820
JJ Haugh
21985 McClellan Rd 408-255-5486
Diana Lopez - Mike Counsil Plumbing
permits@mcplumbing.com 408-272-4900
We would like to request a permit extension for the above mentioned address.
Construction on this project was delayed because we were not able to contact the homeowner
to schedule an inspection date. Due to circumstances that were beyond our control, we were unable to make
progress on this project, and the exipiration of our building permit has expired.
2/14/24
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