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REQUEST FOR 30 DAY TEMPORARY POWEll RELEASE
DATE: LL-J 14 -Ò"7
s-c. LUCIE coum"Y BLDG. & ZONrNG
. DOO \ilRGINIA AVE
FOR'I1 PIERCE, FL 349S1-S~:2
Pb. (561) 461-2165
FAX (56J) 46Z-1148
PERMIT NUMBER;
.SLf' (~.' 1(:' · (J ~I:) <1'
PR.OPJi:R.rry ADDRESS~
tl~l"~l :J ()cEQrJ '-h~r"JeI'fi~'~~) f:X:t](~r'" f3"-J ~
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO
nu: ABOVE DESCRIBED PROPERTY, FOR. A PERIOD NOT TO EXCEED THIRTY (30)
DA Ys, FOR THE PURPOSE OF TESTING SYSTEMS AND EQUIPMENT IN
PREP ÁRATION J'OR FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF
TIΠREQUEST \\'E HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
J. This temporary power release ~D reqnested f{)r tbe abO\.'c Jtar~d purpose oldy,
aDd Ibe,.e will be no OCcupancy of 2"Y typê. other 'haD that permitted by
~()n"1ruetion duriag this time period.
2. As 'Witness by' our sienatUTa. we hereby agret. io .:&bid~ by aU terms aad
-=o.ditw.... of this ai:ru....qat. iudQdlut: Building Divi5ion Policy, ~hich is
ibcorporated be~iD by ref~re.c:e.
3. All C:I)DdiljODS ~bd requiftme..ts Ibted i. the attached døanøeøt entitled
"Reqllirem~nls for 30 Day Power for Te~ItJb.g· bave ~eQ fulfalled aDd the
pre.Ùes is rndy fOJ" L-olbpliallcc ÍDspecfioo.
WE lŒRJœy RELEASE AND AGREE rrO HOl.D HARMLEss~ Sr. I..UCIE COUN'IY,
AND THEIR EMPLOYEES FROM ALL LIABILITIES AND CLMMS OF --\NY TYP~ OF
.NATURE WHlCH MAl': ~E NOW OR IN TIlE nrllJRE our OF THIS
TRANSACJ1ON, INCLUDmG ANY DAMAGES WHICH MAY BE INCURRED DUE "rO
nn: DISCONNECTION OF ~cnuCAL POWER 1N11Π~VENT OF VIOLATION OF
~S AGREEl'4ENT. .. n. .)
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ELECTRIC4 CONTRA.crOR 81 NATDRE
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