HomeMy WebLinkAbout30 day power release f
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Planning Ue i opment Services
- : f Building & Code Regulation Drrsien
2300 ArginiiAve
_ Fort Pierce; FL.34982
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7724- 2-2165 Fax 772-462-6443
i lReques :for 3D-ate` -imporarylower lease:
Date: `t Permit:Number:
Project Address: Q 1'1 b-�W
THE t1NDERSi( VED:HEREBI'REQjUEST-RELEASE OF ELECTRICAL SOWER To THE ABOVE DESCRIBEo
f . NYPUROSE OF TE5ZG SSTEMSPCLQPERTY,.FOR A:PERIODNOT TO..EXCEED THIRTY(3Q)DAYS;EOR:THE
�VfO-AND.EQVIPMENTIN�REpAATIRA..FINALINSPF&UON. IN CONSIDERATONOFAPPR0IFAL: F THE
I REQUEST 1n11 HEREBY ACICMOWL.EDGE�AND AGREE AS4LLOl�1S'
E 1. Thistenporatyppwerrelea%.is.requested:for:theabovestatedpurrgose.only--and.therewill.-heho ,
adet�pancy of any t}rpe,other than that per rr+►tted ly constrcirbn Turing this Gt�t2 y32nacl:
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l 2. As witness by our signar ,We herebyagree to abide bv.a11 tertrLs and,pandrlaons=oP this agreement,
litcigdtng Building 17! 1v idq*Polic y,'which Ss'sncot rued hPs n by i enr e. `
3: All'bbtiditioris anci requ'kWtee is l led in t att cFied docia neat erttftled."Regwreriients for 30bey. '
Pair far Teging"have beeh fulfilled and to premise fs ready fur'complfanct�inspeCfon
} 4: AIP.eq[ sts fior an,extension beyon i 30 days must be made in writing tCt fhe 8�attding flfl`iitf tat sl tipg
tha:>easan for the:request: Rawer'may ba remdveti from the site andjor a Stop Work Order issue if
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the i4hal Trrspection4iE s not tteert apfiroved''with 30 days;, A fee'oF$10D:UO wilt 6e regutrecf to Tiff
WE HEREBY:RELEASE AND'ACREE TO HOLD CHARMLESS ST LUCIE CUUN1`Y,Ai�D THk�R EMPLOYEES'FROM
a ALL t IABILMES AND CLAIMS OF AW..TYPE OF NATURE WHICH NfAX ARISE NOW OR'IN THE FUTt1ftE-OUT
{ OF'fHYS TRANSACTIt#N,Il CLt1DING A fY DAMAGE WHIdi MAY.BE INCURRED I�lE.TO THE
I I7ISC0lVNC-CTION F.. LECTRT POWERJN THE EVEN- aF.VIt?LATION G3F THIS AGREEMEM'. :,'
S � Zo ZA
+DWlVER:S 'IZ1RE.
DATE:.
NTA
R OATE
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