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tiv <br />r /1 <br />h,� I h �f <br />�es�be4he work that has tieen completed to -date: <br />G!% <br />�E�sl�JrN�>°S' � F�Xiv d"NQOaifSj .slAK <br />�srr/al4lbl�� <br />Describe -the work that n <br />1/fl1L:Q jrro", <br />0)j <br />Describe the <br />s to be completed: <br />an extension is <br />Date work will be completed: <br />Section 3: Signature <br />(mm/ dd/yyyy) <br />�AP VAK W <br />4�1'47-� <br />Take notice that an application for an extension constitutes an admission that the Notice of Violations and <br />Order to Correct is factually and proce urally correct and that the violation does or did exist. In addition, <br />the application for an extension cons ' tes a waiver of the right to appeal as to the violation for which an <br />extension is applied. <br />Owner/Applicant Signature: A�ZmaDate: <br />Must be a duly authoritied represe�rta ive of the addressed propery. <br />This request is the: <br />This request is: <br />'nitial <br />Subsequent (number <br />11 Approved ❑ Denied <br />Inspector: Supervisor: <br />Page 2 <br />request) <br />Received: / <br />� 6 U'o I - <br />A] <br />