HomeMy WebLinkAbout30 day for testing Planning & Deveiopment Serwices
Building &Code Regulation Divisi*n
COUNTY
00 �rgi n is Arne
• Fart Piercer FL 34982
772-462-216 5 lFax 77$-462-6443
"uwL for M-Day Terripmary Power Rel v�
Dabc: Z� o zip Permit Number' 1D - i-
Pr;qjei t Addresn= 1 lam. If f e S
'T7-C UNDEPSIGIE4 HEREBY REWEST RE EASE OF ELECTRICAL p )V� TO THE ABOVE DESUM�D
PROP9M, FOR A PERIOD MOTTO THIRTY(301 DAYS,FOR THE RMPOSE OF TESTING SYST
Ah') EQUIPMIEKT Irk FREPAFATION FM A'FliML INSP�Cq — IN 0Y4R-RERATI(X+I OF APPRDVAL OF TKE
MUST WE HERE13Y AC #NO1r T�AM AIPEE AS FOLLOL =
1_ This tEmPOnry pK-cr Teiease zs mqu+A+d for the above sta-d purpose only and there All b-no
n Of arry ty9 ,odw than tW,permiWad by+oxNhx!fKn-dunr*the t gCriQ4.
2_ AT,wit:Ft ,try our signa#onesr we her"&WEe to a6rde by all tears and mrdtws of tits agrmrert,
ffxlxJ,rg Building Dhrj"Policy,vaio is k4mqwr&ed hcrdn by mfj!e. ,
3. Al mnditlorm and n,quircnmf,;IpztEd in t*aWzsd X r,-x-tt W-Reg4iremj!�nts for 3a Day
Pvmx for Tesbrrgff-iaye bm fi_dF&yed wd the Pramtse is ready for orx oianve irr an_
4. All rPXW. ;F3r an exbawon.t tV-7M daV MvA t>i--rft� ki x--?WYj W ft 0ff S)Mtlrg
"-e reasm for the r"xLL z. PQwes may be ceded frarn to site andltx a Simp work Order issued if
tie�naJ Irspe ion T53S not . w7�in 3 y A Fuc of$100,00 will be required bzp liFt
the Swp Work Order_
WF HEREM PE FAQ AND AGREE TO HOLD HAM'PcSr 5T_ LUOE COUNW,AND THEIR EMPIMEES FROM
ALL LL46ILiTIEE AND CLAIMS OF ANY TYPE OF NATURE WH11. >!i MAY ARISE NOW oil IN THE FLFrURE OUT
DF THTS r INaUDINO ANY DAMAGE WHICH MAY BE INCLMAED DUE To THE
D=INE7CL-I0N OF CAL POWER IN THE EVE: TP OF VIUiATION()F THZS AGP EEMEN7T
MreWS1C;N,4 DATE,
GENERAL DkTE
F 1 F C rL7F�J[T {ATLJP-E DINE
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Sca nned wit h Ca rnS canner