1995, 08-01 Permit ExtensionTIIIS FORM IS FOR DEPARTMENT. USE ONLY
REQUEST FOR (6 MONTH) EXTENSION OF PERMIT
THE 5 -STEL' PROCESS
WE NEED 70 FILL OUT TIIIS FORM UPON RECEIPT OF A REQUEST FOR AN EXTENSION.
STEP 1:
DATE REQUEST RECEIVED:
REQUESTED BY: A h 1 %\-D h,
ADDRESS: 0 (pa.
��- O L(D
PROJECT NO:
PERMIT USE:
lis
INSPECTOR DISTRICT:
CL h : . PHONE
f\ Y
E -L7
Cc2J-c_)
REASON FOR REQUEST:
STEP 2: (IF INSPECTOR RECEIVED DIRECTLY FR AP IJCANT- SKIP TO STEP 3)
FORWARDED TO:DATE: 1 i q�
Codes Administrator
STEP 3:
GIVEN FOR CONSIDERATION TO: DATE: 7 3
Inspector
ENTERED "00000" APPROVED EXTENSION IN HANDHELD ON: / 9 14
IF NOT APPROVED, REASON FOR DENIAL:
STEP 4:
RETURNED FOR REVIEW TO:
RSV
Codes Administrator
DATE:
STEP 5:
SENT FOR LETTER TO:
7/7///fil
Offi e Assistant
CONFIRMATION LETTER SENT ON :
EXPIRATION DATE:
ORIGINAL:
DATE:
NEW:
WHEN STEPS 1-5 ARE COMPLETE,
THIS FORM & A COPY OF THE CONFIRMATION LETTER
NEEDS TO BEBE PLACED IN THE ADDRESS FILE.
cxtc,,io.rrm
I /27/94
ACTION: R SCREEN: SITX USERID: M5TI
H- r= ----
BUILDING PERMIT SYSTEM SITE CROSS REFERENCE
JURISDICTION= 11
STREET= EMPIRE DIRECTION= E
STREET# TYPE APT# LOC PROJECT PERMIT TYPES S DATE
01- 010626 WAY SPO 94000840 BU PL ME A 940202
OWNER: LAZANIS, ANTHONY PCL #: 45054.0609
USE: RESIDENCE W/GARAGE - NATURAL GAS
02- 010628 WAY SPO 93011945 ME A 931214
OWNER: LAZANIS, ANTHONY PCL #: 45043.0609
USE: FURNACE, WATER HEATER & PIPING
03- 010628 WAY SPO 93011763 ME A 931208
OWNER: LAZANIS, ANTHONY PCL #: 45043.0609
USE: GAS FIRED WALL FURNACE
04- 010628 WAY SPO 93003608 BU A 930517
OWNER: LAZANIS, ANTHONY PCL #: 45043.0609
USE: STORAGE BUILDING