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Permit Extension Request

2. CCC Dept. of Conservation & Development
   Building Inspection Division
   

4. Permit Extension Request

6. Prior to building permit expiration and upon written request, a one-time extension, not to exceed 180 days, may be granted. Person submitting this request must be listed on the building permit. You will be notified by phone if the extension is granted. If the extension is denied you will be notified by mail.

   
   If you have questions regarding this form, contact the Building Inspection Division toll free at (855) 323-2626.

8. Requester's Information

10. Requester's First Name:*

12. Requester's Last Name:*

14. Requester's Address:*

16. City:*

18. Zip*

20. Phone Number (include area code):*

22. Email:

24. 
    Permit Number (list multiple permit numbers separated by commas):*

26. Job Site Address of Permit. (Separate multiple addresses with semi-colon):*

28. 
    Explain your request for permit extension:*

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field