MECKLENBURG COUNTY Land Use and Environmental Services Agency Code Enforcement Liability Waiver for LP Gas Utility Installers Date: ____________ To: Mecklenburg County Code Enforcement Department Attn: Document Control/Inspections ___________________________________________________________________ (Company Name, address and phone number) will be installing a: ___________________________________________________________________ (Full description) ___________________________________________________________________ @Street Address: ____________________________________________________ City: _______________________ State: North Carolina Zip Code: _____________ Associated Mechanical Permit#___________________ (must have a permitted appliance that you are providing fuel to) We are installing at the above address, a Liquid Propane Tank/first stage regulator assembly, associated underground fuel lines to the second stage regulator, in full compliance with the General Statutes of North Carolina and other laws, rules or ordinances as may be applicable at the time of installation. As the installation of the piping and both regulators are the responsibilities of the LP Utility company, we assume all liability for its installation and hold harmless Mecklenburg County for any and all issues that may arise due to this installation. _______________________________ Operations/Service Manager