HomeMy WebLinkAboutpower release-jj J
LDI
Date; 4/16/2021
Planning & Development Services
Building & CodeRegulatlon Division
23,00 Virginia Ave
Fort Piercer FL 34982
0772462-2165 Pax 7724 2-6443
MAL
Permit Number:
Project Address: Lot 47 5173 Armina Place
►o-o69S
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 04F TH
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS. FOLLOWS,
is Th"ts temporary power release is requested for the above stated purpose only, and there will be no
occupancy of any type, other than that permitted by construction during this time period.
2. &,witness try 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.
3: All conditions and requirements listed in the attached document entitled "Requirements for 30 Day
Power for Testing" have been fulfilled and the premise Is ready for compliance inspection.
All requests for an extension beyond 30 days must be made in writing:to: the Building Official stating
the reason for the request. Power -may be removedfrom the site and/or a Stop Work Orderissued if
the Final Inspection hasnot been approved.:within 30 days. A fee of $100.00 will be required to lift
the.Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST, ICIE COUNTY, AND THEIR EMPLOYEES FROM
ALL LIABTLT`fTES AND ci_ATMS OF ANY TYPE OF NATURE WHICH. MAY ARISE NOW OR TN 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.
I�ev�n; i`�gl'���1'�la�;�X11 4/16/2021
OWN R S �ATURE DATE
l
GENERAL CONTRACTOF(SIGNATURE
ELECTi�ICAL CONTRACTORSIGNATURE
vseph $palk 4/16/2021
DATE
4/16/2021
DATE