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2. Extension Request

   Extension request for active cases may be approved by staff only if the applicant can prove progress towards correcting the violation(s) listed in the notice.

   Any request for an extension to a hearing must be submitted to the Code Compliance Department no later than 10 business days prior to the scheduled hearing. The City’s final determination will be based on a number of factors, including but not limited to the following:

   • The gravity of the violation(s)
   • The length of time and effort it might take to obtain compliance
   • The history of code violations at the property in question
4. First Name*
5. Last Name*
7. Relationship to the property*
9. Address 1*
11. Address 2
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Email Address*
20. Nature of the case(s)*
22. Case Number*
23. Time Requested*
    -- Select One --30 Days60 Days
25. Reason for request*
27. Any supporting documentation*

    1. Yes (If yes, please attach documents)
    2. No

    It is the responsibility of the property owner to contact the Neighborhood Services Department for a Re-Inspection when the violation(s) have been corrected.

29. Supporting Documents
31. Applicant Name*
33. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in thesense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signatureto be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still berequired to provide a traditional signature at a later date.

    1. I agree.
35. Applicant Electronic Signature*

    First M. Last

36. Date*

    mm/dd/yyyy

40. STAFF PURPOSES ONLY

    1. Code compliance Officer Name: ________________________________

       Date case was opened: ___________________________

       Is a recent photo attached? ___________________

       • Support Request, Suggested Extension
         • 30 days
         • 60 days
       • Deny Request

       Any prior extensions granted:

       • Yes
       • No

       Are there any other pending violations for this property:

       • Yes
       • No

       CCO Comments: ______________________________________________________________________________________________________________________________________________________________________________________________________________

       ______________________________________________

       Code Compliance Officer Signature: ______________________

       Date: _________________

       Reviewed By: _____________________________

       Extension Granted:

       • Yes, Time Granted: ____
       • No

       Management Comments: __________________________________________________________________________________________________________________________________________________________________________________________________

       Reviewer Signature:__________________

    2. Date: ___________________

    3. ________________________________________

    4. Saved into case file by: ___________________

       Applicant Notifies by:_________________

Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field