HomeMy WebLinkAboutRS160070_Extension FormPublicWorks
Request
q, 1Extend Plan
Check/Permit
Date: -'S - Z' 14
Attention: Hadi Tabatabaee, County of Orange Building Official
Job Site Address: c c� n 5' V, IK- /,'n ce—
Permit Number(s): 10F t< Z0 ; ►K J460p 36'
1
I, /fvc h cx h a/ Py', lG 0,e , the project (owner/contractor/designer) of the above referenced
permit(s), would like to request an extension. Reason for request: rfWIA5' ®,* -j 6-,
i1 5; 46' cg '7 a > /11 L ilv'o o -5;7 Z lG'r� C3 v ii'- /; / dGo o z4fs'
Name: lx<el r`. cyc ,c W hl.l o Ae
Telephone Number: 9y9 `�m
E-mail address: hlt ,., s, We /-- 7,e. a el C b�
7W
✓ Please note there is a $154.50, non-refundable fee for all requests to extend Plan Checks or Permits.
(OC Board of Supervisors Resolution No. 15-017, adopted March 10, 2015.)
F R OFFICE USE ONLY
County Approval rr Date
Extension Ti ne �� er Expiration Date
nn
Extension Fee Yes 1 `L No ED Note
300 N. Flower Street, Santa Ana, CA 92703
P.O. Box 4048, Santa Ana, CA 92702-4048
www.ocpublicworks. corn
P: 714.667.8888 1 F: 714.667.7575
Revised 412017
ocpCustomerCare@ocpw.ocgov.com