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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 B708 CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION PLAN CHECK EXTENSION REQUEST PROCESSING FEE: $105.00 Permit applicant, please complete this form and submit it with payment, in person or mail, to the Building Division at 200 S. Anaheim Blvd., Suite 145, Anaheim, CA 92805 Last Name First Name Company Name Mailing Address (Street) City/State/Zip (Area Code) Phone Number E-mail PLAN CHECK INFORMATION Job Location: List all Plan Check Numbers: State Reason for Requesting an Extension: I HEREBY CERTIFY THAT THE ABOVE STATEMENT IS TRUE. Signature Title of Applicant Date Office Use: Current Expiration Date: ( ) Fees paid ( ) Processed in Tidemark Department Action: ( ) Denied ( ) Approved - Updated Expiration Date: Name Date Comments: Following a decision on the extension request by the Building Division, the applicant may request a letter outlining the Division’s findings.