HomeMy WebLinkAboutPower ReleasePlanning & Development Services
Building & ICode Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34962
772-462-216S Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date: c� Permit Number;`'dp�_�
Project Address:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS: AND EQUIPMENT" IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF TFIC
I. This temporary power release is requested for the abnve stated purpose only, and there wiN be rro
Occupancy of any typv_, other than that permitted by construction during this time period.
2. As witness by our signatures, we hereby agrFe to abide by all terms and conditions of this agreement,
including Building Division Policy, which is Inrorporated herein by reference,
3. All conditions and requirements listed in the attached document entitled "Requirements for 30 pay
Power for Testing" have been fulfilled and the premise is ready for compliance Inspection.
4. Ali requests for an extenslon beyond 30 days must be made in Writing to the Building Official stating
the reason for the request. Power may be removed from the site and/or a Sty Work Order issu- it
the Firnal Inspection has not been approved within 30 days. A fee of IOD,Ot7 will be requireh to lift
the Stop Work Order,
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ,ST, LUCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
1
IGPiATURE
GENERAL CONTRACTOR SIGNATURE
ELECTRICAL CONTRACTOR SIGNATURE
DATE
�j DATE
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