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F 10 R I D A -
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Ave
Fart Pierce, FL. 34982
772-462-2165 Fax 772-462-6443
Request for, 30-Day Temporary Power Release
Date. _ /O Permit Number;
Project Address: _XJ
�— `
THE U✓`IDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE A80VE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSP[=CTION. M CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1. This temporary Power reiease is requested 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 herein by reference,
ments for 34 D
3. M conditions and requirements listed in the attached document entitled "Requireay
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 writirk) to the Building Official stating
the reason for the request. Power may be ►en)oved from the site andlor a Stop Work Order issued if
the Final Inspectdorti has not been, approved within 30 days. A fee of S100,40 will be required to lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROd�I
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF MATURE WHICH MAY ARISE NOW OR IN THE FUTURE Ol1T
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY 8c INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
NER SIGNATORI
GENERAL CON-rRACTOl; SIGNATURE
LLECTRICAL CONTRACTOR
OAT
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