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HomeMy WebLinkAboutNSFR2015-0788r,cT I.3 201! CITY OF GRAPEVINE TEMPORARY ELECTRIC RELEASE Temporary electricity has been requested for the purpose of construction, remodeling, addition or improvement to the following described property. It is understood that this release in no way authorizes occupancy of the building. It is further understood that this temporary release is for a thirty (30) day maximum time period and the undersigned releases all claims that may occur through accidents or spoilage of any type resulting from said electric power being turned off at the end of the thirty (30) day maximum time period. ADDRESS LOCATION OF TEMPORARY ELECTRIC RELEASE: ADDRESS: i -Z' L1 ( h( UP,6-YL) PERMIT NUMBER: ) S ._ © 7X S CONTRACTOR INFORMATION NAME OF APPLICANT: Kr1L�U ADDRESS OF APPLICANT: 1S c J /✓ /$�: /°!C 1% CITY, STATE, ZIP: Y3 L_ A yw TELEPHONE NUMBER: L C _ LI q L_ INSPECTIONS FOR TEMPORARY POWER MUST BE REQUESTED AT (817) 410 -3010 D� to cz'L j o / �- i_o z, PRINT NAME: DATE: �— 13 -rr zn i BUIL ING FFICIAL SIGNATURE: DATE: O: FORMS\OS CONTRACTOR FORMS \TEMP ELEC.doc 10/12100 Revised 4/10/02 CITY OF GRAPEVINE OCT 13 2015 TEMPORARY GAS RELEASE Temporary gas has been requested for the purpose of construction, remodeling, addition or improvement to the following described property. It is understood that this release in no way authorizes occupancy of the building. It is further understood that this temporary release is for a thirty (30) day maximum time period and the undersigned releases all claims that may occur through accidents or spoilage of any type resulting from said gas power being turned off at the end of the thirty (30) day maximum time period. ADDRESS LOCATION OF TEMPORARY GAS RELEASE: ADDRESS: 11'O/ 1 Lill, V 0 PERMIT NUMBER: M -O 7 E? CONTRACTOR INFORMATION NAME OF APPLICANT: k k-1 ADDRESS OF APPLICANT: ) LA/ % ./77167 CITY, STATE, ZIP: TELEPHONE NUMBER: **** W*** W** WW******* W********************** WWW* W* W** WWW* W* WWW* W* WW*** * *W * * * *W * * * * * *WWW * * * * * * * * * * * * ** INSPECTIONS FOR TEMPORARY GAS MUST BE REQUESTED AT (817) 410 -3010 OrWl, - Al t4 L6' 19 Z% PRINT NAME: DATE: rG a. al BUILIQING \OFFICIAL SIGNATURE: O: FORMS\DS CONTRACTOR FORMSTEMP GAS fti, 10/12/00 Revised 4110102