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NTY
F L O R I D A
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Planning & Development Services
Building & Code Regulation DivWon
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
�'royw Address _ �w
THE UNDERS'GNED HEREBt REQUEST RELEASE OF EI.ECTRIfAt
P'O�R 1 y, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS. fj--
A40 EQUIPMENT IN PREPARATION FOR A FIML I%SPEMOtt. c'. `„' - = _ . _ ,• - - y = _ _ � ~ _ = -
REQUES°r %VE ME +=BV ACKN'OWLE-DU MD AGREE AS=OCLOW5
ter+Wary Power
Gct�C'8r'{y OF &tr tVPp, OMN t►Wn rtWt PlknCed Gi :c?n6b r:•-• = .
As *1m. *SS by Our Signarwes, we herepr ; tRs a. =
"1�r9 &rfd UYtSsDn '�'� � � y► 3! ter - >-
OP CA'+diCr& N r �"' wlw� rs �PGrdZed here+n t`, re`n+m
D 'Test"' r'W��rr12.:S Weed n the &"J.&i OxLve owe -'or. have been ILAr&ed aye thr ate is rpm,
q AN re ques S for a-t fttenson 30 days r1*M be r %-xk n r,! - • - ,
M�! re Sqn for CM Fe0toftit. Aywe+ rTYN be rMM ►ed f4ow pe site irti =
tM Fine] lr%4 ton has not beery XY3(Cr+W watM 30 dars _ S
!*e Stv work Order -
WE HEREBY RELEASE AND AGREE TO *X—!) NARMCESS, ST. LtlCI _ `, - _ _
! LL LIABIL.ITIES AND CLAIMS OF ANY TYK OF NA-r ,ti ;`y_ F _` _ ,;JON
OF THIS TAA7NSACrIGN INCLUDI%G ANY DAMAGE Atf[C►i MAY � Il : _ = =�, � ! - - �_- JT
-
DISCONNECT10% OF ELECTRICAL POWER IN THE EVENT OF 1RAATlOk OF TtgS A� - _ _yE•`
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