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f.� Building & Code Regulation Division
COUN 1 230O Virginia Ave
Fort Pierce,FL 34982 _ RECEWL
772=462-2165 Fax 772-462::-644
MAR 31 2020
ST.Lucie County, Permitting
Request for 30-Day Temporary'Power Releas
Dater. 'l9'? ' Permit Numbers j 90� •Ol :
Project Address: _qy t 9er-4 ssle;r. L ari.
THE UNDERSIGNED HEREBY,REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND-EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION; IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS,FOLLOWS:
1. This temporary power release is requestedd-for the above stated purpose only,and there will be no .
occupancy of any type,other than that permitted by construction during this time period.
2. As witness by our signatures,We hereby agree to abide by all terms and conditions.of this agreement,.
including Building Division Policy,which'is incorporated hereinby reference.
3. All conditions and requirements listed in the attached document entitled"Requirements for 30 Day .
Power for Testing"have been fulfilled and the premise Is ready for compliance inspection.. ,
4. All requests for an extension beyond 30 days must be made in writing to the Building Official stating
the reason for the request: Power maybe removed from the site and/or a Stop Work Order issued If
the-Final Inspection has not been approved within 30 days.. A-feeof$100.00 will be required to lift
the Stop Work Order:
WE HEREBY.RELEASE AND AGREE TO HOLD HARMLESS,ST. LOCIE COUNTY,AND THEIR EMPLOYEES FROM
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE'OUT . '
OF THIS TRANSACTION,INCLUDING ANY DAMAGE WHICH MAY BE.INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER'IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
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O E IGNATU DATE
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NERAL CONTRACTOR"SIGN URE DATE
ELECTRICAL CONTRACTOR SIGNATURE DAtrE