HomeMy WebLinkAboutGUADD2018-2219 I1EC 0 � Z01�.�
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: �1 ��� -5
PERMIT NUMBER: 0/ 151-L2 L- /L L. /Y- )- 7 `75
CONTRACTOR INFORMATION
NAME OF APPLICANT: t `"5 p v y I vL F
ADDRESS OF APPLICANT: 506 C^c' �Q ( z�
CITY, STATE, ZIP: -76 C) s( ('
TELEPHONE NUMBER: �/I 7 T/
INSPECTIONS FOR TEMPORARY POWER MUST BE REQUESTED
AT (817) 410-3010
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SIGNATURE: PRINT NAME: DATE:
UILDING OFFICI NATURE DATE:
O:FORMS\DS CONTRACTOR FORMS\TEMP ELECdoc
10/12100 Revised:4110/02