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200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building AUG I 2019 B701 CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION PERMIT EXTENSION REQUEST PROCESSING FEE $105.00 Provide all information below and mail to: Building Division at 200 S. Anaheim Blvd., Suite 145, Anaheim, CA 92805 Last Name First Name Company Name Mailing Address City State Zip (Area Code) Phone Number E-mail PERMIT INFORMATION Job Location: List all Permit Numbers: State Reason for Requesting an Extension: I HEREBY CERTIFY THAT THE ABOVE STATEMENT IS TRUE. Signature Title of Claimant Date Department Action: ( ) Denied ( ) Approved Name Date Comments: