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HomeMy WebLinkAboutElectrical Release AgreementST_ LUCIE COUNTY BUILDING DEPARTMENT ELECTRICAL RELEASE AGREEMENT APPLICATION DATE i fo OWNER�-1' I;d!' PHONE CONTRACTOR ?SS'�C�a �� kJ U� tC`Q1� Oe'C'dP�HONE BUILDING PERMIT NUMBER 9 S__ 1 Z 0 3 -7 5 ADDRESS 3 S 2 S— I -I%- M % CI w�,,j ). CI RECEIPT NUMBER L 64 1. o PERMIT DESCRIPTION i�'-' C 1 ^ C c7 Y''1 A-\-e/ e -+- RELEASE OF ELECTRICAL POWER IqqS REQUESTED FOR: `l �(f l j� REASON: 1 © W k. d' K v T C � � C I� 0. � CI e `F �C�� lJ % 1 � 4, t rl' A ` D Pry J Q^--P �vr \ 2 r Z OMA . NUMBER OF METERS REQUESTED C1i0 S>?C5 ACKNOWLEDGXI NT AND AGREEMENT: Release of electrical power is requested for the above stated purpose only. There will be no occupancy of any type, other than that permitted by construction during this time period. As witness by my, signature, I do hereby agree to abide by all the terms and conditions of .this agreement-,- including Building Division Policy, which is incorporated by reference as herein. I do further agree and permit St. Lucie County to have electrical power discTected.for ny violation of this agreement. I (print) �n intending to be legally bound, hereby release and agree to hold harmless, St. Lucie -County and their employees from all liabilities and claims of any type or nature which may arise now or in the future; out of this transaction. Including any damages I may incur due to the disconnection of electrical power. I further agree to indemnify St. Lucie County and their employees from and against any claims, damages, losses and expenses including attorney'a fees arising out of, or resulting from the execution of this agreeme t. APPLICANT DATE (OWNER/PERMIT QUALIFIER) Sworn to and subscribed before Building Codes Supervisor DATE me this *h day of A.D., 19 khtc-NJA a Notary Public State of Florida My co�jg}31��A�InA.eI������R Notary Public State of for Commission #CC242116 Expires November 16, 1996 O C C U P A N C Y I S N O T R M I T T E D