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Request for Extension

  1. Section 1: Owner and Applicant Information
  2. Section 2: Violation Information
  3. Example
  4. Section 3: Agreement*
    Take notice that an application for an extension constitutes an admission that the Notice of Violations and Order to Correct is factually and procedurally correct and that the violation does or did exist. In addition, the application for an extension constitutes a waiver of the right to appeal as to the violation for which an extension is applied.
  5. Must be a duly authorized representative of the addressed property.
  6. Office Use Only
    This request is the: Initial or Subsequent (number ________ request) This request is: Approved or Denied
  7. Received:________________________________________________________________ Inspector: ______________________ Supervisor:______________________
  8. Leave This Blank:

  9. This field is not part of the form submission.