REQUEST FOR EXTENSION OF PERMIT
MARIHUANA FACILITIES
Facility Name: _________________________ Permit # ___________
Address: ______________________________
The City of Adrian Code of Ordinances, Chapter 46, Section 502(f) states that if a permit holder
has not obtained a valid state license at the end of 180 days, they may request an extension of
time. The granting of an extension shall not exceed 120 days or the expiration date of the current
permit.
I, ________________________________, hereby request an extension of the permit for a
Medical Marihuana Facility issued to me on ________________. I request an extension of:
30 days
60 days
90 days
120 days
Reasons for Extension (please attach a separate page if necessary)
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I, _______________________, understand that a staff review of this request for extension is
required. I have attached all relevant documentation to this request, including but not limited to
site plans, investment documentation, correspondence with the State of Michigan, etc. Failure
to provide the required information may result in denial of the extension.
__________________ __________________________
Date Signature
