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Planning & Development Services
Building & IICode Regulation Division
2300 Vilrgit is Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for, 30-Day Temporary Power Release
Permit Nuniber: ____P' 00(0 =�
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Project Address: .S ---------�--------
THE LIN )ERSIGNED 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
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
This temporary power release is requested for the above stated purpose only, and there viiil be no
occupancy of any type, other than that permitted by construction during this time period.
As witness by our signatures, we hereby agree to abide by all terms and conditions of this agreement,
including Building Division Policy, which is incorporated herein by reference.
Ali conditions and requirements listed in the attached document entit!&J "Requirement; for 30 Day
Power `or Testing" have been fulfilled and the premise is ready for compliance inspection.
Allrequests for an extension beyond 30 daYS must be made in viriting to the Building Official stating
the reason far the request. Power may be removed from the site and %cr a Stop Work Order issued if
w i=i tfrral Inspection has not been approved ryithin 30 days. A fee of $100.M will be required to lift
the Stop 4�,ork 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 INCURREtD DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT
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