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Building Approval □ Planning Approval □ EH Approval □ 5100 Bullion Street Mariposa, CA 95338 Building [PHONE REDACTED] Environmental Health [PHONE REDACTED] www.mariposacounty.gov [EMAIL REDACTED] [EMAIL REDACTED] Permit Extension Request Please complete the following form and upload this to the online permitting portal or return it to the Developmental Services to request an extension for your permit for 180 days. All extensions are subject to approval from the Director. It is the owner’s responsibility to keep all permits current. An inspection is required to take place within 180 days. Project information Project Address: Permit Number: APN: Type of Permit: Current Property Owner: Phone Number: Current Mailing Address: City: State: Zip Code: Email: Previous Owners Contact Information (If Applicable) Previous Property Owner: Phone Number: Current Mailing Address: City: State: Zip Code: Email: Please provide information as to why a permit extension is being requested. If more information is needed, provide additional pages as needed. Signature: Date: SIGN