HomeMy WebLinkAbout30 dayPlanning & Deveiopment Serwices
Building & Code Regulation Divisi*n
COUNTY
00 �rgi n is Arne
• Fork Piercer FL 34982
772-462-216 5 Fax 77 $-462-644 3
"uest for 30-Day Tmpmarf Power Rel *w�
Dabc: Z 4p o zip Permit Number- 7-2�-D C;-- - 0 i-
TKE UNDE ZK13NED HEREBY REWEST RE SASE OF ELECTRICAL P� TO THE ABOVE DffAI?SEi�D
PROPERTY, FOR A PERIOD MOTTO THIRTY (301 DAYS, FOR THE RRMSE OF TES NG SYSTEM
AND EQUIPMIEKT Irk FREPAFATION FM A gNAL INSPE CMN- If+1 WNSIDERATI(M OF APPROVAL OF TKE
i UE35T WE HERE13Y A #+IO1r T� AM SEE AS FDLLOL =
1_ This tEmPOnry rK-cr Tgease as muw-Aud for the above stud purpose mhyr and there wdil k- no
u0nulmnq & ary , odw than ITW, permif pd bp� oxNhx!fKn -during the t geriO4.
2_ AT, with, try our signatones, we her" awe to antde by all tears ard mrddthves of U-i s agmurert,
ffxlxJ,rrg Building Dhr�" Policy, varo is incorpwLted herein by mfererpm,
3. AJI mnd113arm and n--gOrenmEYm IPztEd in t* aWed ied OaXk tyitj W -Reg4iremj!�n1s for 3a Day
Pvwu for Tesbrtg": ram *m fi_dFb:)d aid the premise is nerdy for orx oiamve it on_
4. All rPXWAs Far an e:titmsion beyarr- 7m daV rovA t>i-- n%ki iAr W ft WcL4 simtlry9
"-re realm for the r"xnz. Power may be 7Qlry ed frorn to site aniVor a 51mp work Order issued if
t.re AM Impeotrm baS not keen 3 M%wW W7bn M dWs, A'cc of $100.GO will be required bzp IiFt
the Swp Work Order_
WF HEREM PE FA5E AND AGREE TO HOLD HAM' PCSr 5T_ LUOE COUNW, AND THEIR EMPIMEES FROM
ALL LL46ILiTIE5 AND CLAIMS OF ANY TYPE OF NATURE WH10i MAY ARISE NOW oil IN THE FLFrURE OlIT
DF THTS r INaUDING ANY DAMAGE WHICH MAY BE INOMID DUE TO THE
D=NNECL-ION OF-B=TRICAL PDWER IN THE EVENT OF VIg1ATION OF kKIS AGPEEMEN7
GENERAL
STGNATUPLE
f W
DATE
Sca nned wit h Ca rnS canner