HomeMy WebLinkAboutPower Release' Uv i sL L.
�� �,; _•, L L tom:
Important: The occupant of the property (or other appropriate party) shall have made proper
application to the electric utility, paid any applicable fees or deposits, and requested power in a
timely and informed manner. St Lucie County is not responsible for any delays in the receipt of
electric power_
We acknowledge and accept the terms of this permission. We further acknowledge that violation
of this agreement or a finding of unsafe conditions and/or practices found on the site or occupancy
of the site may result in immediate disconnection of this temporary power without warning and
hereby release St Lucie County and all representatives of any and all liability resulting from us not
abiding with this agreement.
'F-D',�5 l= tE-LTre- 1C-
Print Name - Electrical Contractor Company Narne
1 1131
Signature - Electrical C for Date
�dU3 � A dS_
Print Name - Electrical Contractor
ri7`) 20 ( - 7 F� 3 2—
Phone Number - Electrical Contractor
License # Electrical Contractor
Signature -Owner Date
sA v-•1.s
Print Name - Owner
f - 1A S' =
Phone Number - Owner
i5`ga-ture - Pric antr�e r ate Print Naime - Prime Contractor Company Name
722-4
Print Name - Prime Contractor Phone Number - Prime�or
01,6" C- 0VV60Y
License # Prime Contractor
Approved for St. Lucie County by:
Signature - Electrical Inspector/BO Insp ID #
Inspector comments, limitations and restrictions:
Date
I