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B-2017-0377 Extension Request
CITY OF 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: c.:%1 Owner Address: Phone: Contact Name: 1.41 E-mail Address:4s C- e rv`'-I , ��)I— Phone: 6so) � Sa n Reason(s) (please be specific): �rf ,/ �,- Signature: ,(� fy Date: % ! j�% (CITY OF CUPERTINO USE ONLY) Yes No Approval: ❑ Expired Date: Fee: $ 1ir1 . tom- �� LL Revised 7/25/2017