HomeMy WebLinkAboutPower ReleaseST. War
COUNTY
F L O R I D A
Planning $ Development Sertvices
Building & Code Regulation Division
2300 VirglZ Ave
Fort Pierce, FL 34982
772-462-216S Fax 772-462-6443
Request for 30-Day Temporary Power Release
' — Permit Number: O
_ a 0� (///��►`/ ('^
rN
SIGNED HEREBY" REQUEST RELEASE OF ELECTRICAL POWER THE ABOVE ESCRJSED
PROPER'Y, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PUR OS OF TESTING SYSTEMS
>~�!L EQ:IIahiEN- IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPRCAIAL OF
REQJE`` kVE HI ;ESY ACKNOWLEDGE AND AGREE AS FOLLOWS: THE
-`+is ter�p�,ra y- power ralease is requested for the above stated purpose ortii and there
yr l be 2. �c�l2nc)- of any type, other than that permitted by construction during this time period.no
"r'-Hess by our signatures, we hereby agree to abide by all term; and conditions of this agreement,
r':ciuc -rg Building Division policy, which is incorporated herein by reference.
:Qrdr;iors and requirements listed in the attached document entit!ed "Requirements for 3r3 Day
PJwer for Testing' have been fulfilled and the premise is ready for compliance inspection
Ali-equest, for an extension beyond 30 days must be made in'Writing to the Building Official sta;i•,q
tte reason for the request. Power may be removed from the site and/or a Stop Work Order issuedit
tt'+e Final Inspection has not been approved within 30 days. A fee of $100.00 will be required tG l.ft
^e Stop Work Order,
VVE HERBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AND THEIR EMPLOYEES FR04
A:t LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TF,ANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREErMENT,
a&---
a'NEP 5I"GNATUR=
GEIIERAL COrJ ACTOp, SIG ATUR.E
r-Ltc r KILAL CONTRACTOR SIGNATIJRE
�l- alDd 1
DATE
5--11 C1011
DATE
uar