BLD-2020-0044 Request for Permit ExtensionREQUEST FOR PERMIT EXTENSION
Please e-mail the completed form to
permitcenter@cupertino.org
UPERTINO
❑ Under Plan Review Process Q Issued Permit
Building Address: /y q-4�;t N O C1\ % W-) - I ' l?0 Permit Number: RL-0-.2y20 —00-11- 4
Owner Name:
_ c
Owner Address: �o(� 7 P,S S Cl ( one: _() CCU-' 07/
Contact Name: _VIC /
E-mail Address: Phone: rl4-o&) q kb- 0-? `d
"q1 L
Reason(s) (please be specific):
-1 -7-f W t �iTMq F-, X-TiJ In
Signature: vv__Date: O,&1q- =?2-3
(CITY OF CUPERTINO USE ONLY)
Yes No
Approval: MI
TK
❑ Expired Date:
Fee: $ 1 2- 1 % 0 0
X� (211` 02023
Revised 7/25/2017