1996, 01-17 Permit: 93010599 EntensionTIAs FORM IS FOR DEPARTMENT USE ONLY
REQUEST FOR (6 MONTH) EXTENSION OF PERMIT
TILE S -STET' PROCESS
Wt NEED 70 FILL OUT THIS FORM UPON RECEIPT OF A REQUEST FOR AN EXTENSION.
STEP 1: !� / � f 7 ( j0
DATE REQUEST RECEIVED: / %% Jam'
REQUESTED BY: U t/0� (no le /\
ADDRESS: 1—\Cj(3 ? k) (:i,4,9 I\Q-LA) � 19 �l (9
PROJECT NO: cE - 0 /0,51?
PERMIT USE: Nkt 0 O K0
REASON FOR REQUEST:
INSPECTOR DISTRICT:
PHONE #: ?J4/- 73
STEP 2: (IF INSPECTOR RECEIVED DIRECTLY FROM APPILJNT- SKIP TO STEP 3)
FORWARDED TO:
Codes Administrator
DATE: 1 /
`l(
STEP 3:
GIVEN FOR CONSIDERATION TO: DATE:
Inspector
ENTERED "@669'0" APPROVED EXTENSION IN HANDHELD ON:
IF NOT APPROVED, REASON FOR DENIAL:
//r
STEP 4: •\\
RETURNED FOR REVIEW TO: =% "
Codes Administrator
DATE:
STEP 5:
SENT FOR LETTER TO: DATE:
Office Assistant
CONFIRMATION LETTER SENT ON :
EXPIRATION DATE:
ORIGINAL:
NEW:
WHEN STEPS 1-5 ARE COMPLETE,
rms FORM & A COPY OF THE CONFIRMATION LETTER
NEEDS TO BEBE PLACED IN THE ADDRESS FILE.
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