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Building & Code Regulation bion
2300 Virginia Ave
Fort Pierce, FL 34382
772-462-2165 Fax 772-462-644
Request for 30 -Day Temporary Power release
Projea Address' —1 '3 - f "v
THE UNDERSIGNED HERE'" KQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERI0O NOT TO EXCEED THIRTY (30) GAYS, FOR T14E PLI RPOSE OF TE -'-M NG SYST FEM c3
AND EQUIPMEKT IN PREPARATION FOR A FTNA,L. !NSPE O -H- IN CONSIDERATION OF- APPROVAI. OF THE
REQUE5T WE HERE AO(NOWLEDGE AND AGREE AS FOLLOWS-.
1, TW tempc'rar� pD wer release is riequs6ed for the alb sitaled Purim , and there will be no
occLrpartcy Gi any I , Other than &iat pemitted by cmv5vuctim dmirks 1 period,
7- As witne s try ow *natures, we heFeby agree to ahift bV aH tem-- and cwKMkm of ; age
including Puildmog 13nmc" Fthcy, Which is kxmqporated err by MfeMXX.
3- Alb condit ons and- requiro ntS l In the atta€hed cbnxFmNt epti ed �Rewreniients W 30 Day
Fomes fcw iesWg' h&oe been fulfilled and the Prean -w.. js reKjV for Miaince impection,
4- M requests fbr an emtemm beyund 3j3 days must be made in erg to Uv Bolding Offoal sUbN
t reasm for the requesL Power may be remmed from the 91te anim a St3p ' cm*, Order im"Led if
the Finai TRWetbw hm rK bm approved within 30 dam, A fee of $1U4,I be required to lift
the Stop Work 0 der.
WE HEREBY RELEASE ASE AND AGREE TO HOLD HARMiJE, ST. UJCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIABILITIES AND CLAIM OF ANY TYPE OF MATURE VIA-111CH MAY A�USE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAKAGE WHICH MAY BE INCURRED DUE TO THE
t3LcMNNECTT0a OF EEECTI ICAL EWER IN TI -If r VENT OF VIOLATION OF TKI5: AGREEMENT.
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