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F L O R I ID A'
Planning & Development Seivices
Building & ICode Regulation Division
2300 Virgl�la Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date, J=�.� Permit Number,
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
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL QF 'rl lF
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1, This temporary power release Is requested for the above stated purpose Only, and there �,jlli by ntr
orcuparncY of Any type, other than that permitted by Construction during this time period,
2, As witness by our signatures, we hereby agree to abide by oil terms and conditions of this Agreement,
Including Building Division Policy, which is Incorporated herein by reference.
3. All conditions and requirements listed in the attached doc:untent entitled " Requfremenis for .3(3 r)ay
Power for Testing" have been fulfilled and the Pi emise is ready For compliance inspection,
d, Ail requests for an extenSInn beyond 30 d3y5 must be made In vaiting tc the Building official stating
the reason for the request. Power may be removed from the site and/or ci Stop Work Ardor Issued if
the Final Inspection has not been approved within 30 days. A fee of $100,00 wlli be required to iirt
the Stop Work Order,
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST, LUCIE COLINrY, 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,
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1 �
GENERAL CONTRACTOR
ELECfRIGAL CONTRACTOR 5
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