HomeMy WebLinkAboutIND2017-3177 DEC 19 2018
CITY OF GRAPEVINE
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: 31 9 3 44 $ Pro pro✓-c. �,�,�✓,„.� fX
PERMIT NUMBER: _rvD /7- 31?1
CONTRACTOR INFORMATION
NAME OF APPLICANT: Fib, pt.-p-oac)
ADDRESS OF APPLICANT:
CITY, STATE, ZIP: rJ7t,.o
TELEPHONE NUMBER: 2/et! Zoo . S► V
INSPECTIONS FOR TEMPORARY GAS MUST BE REQUESTED
AT (817) 410-3010
SI`GNATU0, PRINT NAME: DATE:
BUILDING OFFICIAL G E: DATE:
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10/12/00 Revised:4/104