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City of Anaheim PLANNING DEPARTMENT Building Division APPLICATION FOR TEMPORARY UTILITY SERVICES JOB ADDRESS: BUILDING PERMIT NUMBER: Request is hereby made for the temporary use of utility services for subject project only for the time specified. I am fully aware of Section 109.1 of the California Building Code which indicates, in part, that no building or structures shall be used or occupied until the Building Official or authorized representative has issued a Certificate of Use and Occupancy. I hereby acknowledge that as a condition for consideration and granting approval of a Temporary Utility Release, that the temporary utilities approval will become null & void upon the listed expiration date, and therefore, I acknowledge and understand that upon the voiding of the Temporary Utilities agreement, lawful authorized use of said utilities will no longer be approved and be subject to termination and disconnection of said utilities. Any extension of time to this Temporary Utility Release request will be granted subject to review and approval by the Building Official. There will be an additional fee of $186.18 for any request to extend the time of this release. I understand that the fee is non- refundable if this application is denied. REASON FOR REQUEST: Type of Utility: Electric Gas Reason for Temporary Utility Request prior to final sign-off? How long will the Gas/Electric be needed? The party signing below hereby agrees to hold the City of Anaheim, its officers and employees free and harmless from any incidence or occurrence which may occur as a result of this release. The Electrical Contractor, or his authorized representative, shall keep the electric metering and equipment room(s) locked at all times with the only key in his possession. Signature of Applicant Date Telephone Email Address