HomeMy WebLinkAbout30 day power release form 8217 Maidencane PlSl6/2021
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1'huuling �1 I)ovelapmenl 3crvices beparlment
� � Iluilding & Codo Requlationa Division
a 1)00 Vlrglnin Arenue
- Pt Pleree, ML 1/9g3
Phmtdi 1/2-AU1.11Gl.
.'Psi 771-162-1321
Request Cor 30-Duy'Cmaporary Power Release
Dan: ��s=�.r
PorndlNuntbcr: y,l (7z^ �'7f�
Pro)ccl Addlrss; �L���f�n�yf
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO TILE
ABOVE DESCRIBED PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, [+OR
THE PURPOSE OF TESTING SYSTEMS AND EQUIPMENT IN PREPARATION FOR FINAL
INSPECTION. IN CONSIDERATION OF APPROVAL OF THE REQUEST WE HEREBY
ACKNOWLEDGE AND AGREE AS FOLLOWS:
1, Tlds tempornry power release Is requnled for the ebave stnled purpose only, and tkerc tvlll be no oceupaury
of any type, other Ihno Ihnt pennllted by cmuh•ucllon during Ihls time period,
2. As wllnrss by om• slgnntm�es, we bm•eby agree [o nblde by nil lcrnu and conditions of thb agrecnunt, Iraludlog
DoDding DlvWon Policy, wWdt L+ Ineorpontcd herein by rcfercuce
3. AD condllloru nod regniremenu IOled In the atMebed document entitled °Requirements (or 30 Day Power (or
�. Testing' bnve been fulfdled and lbe pre mise is ready for compliance iospecltou.
5. All rcquecU for an ezlensioo beyond 30 days must be made in writing to the Du1Id(ng Official sUtiag the rsasau
Ims n'ol be n opprovcd within 30ca�o�ved� f m of 5100.00 avlll he rcqulredlt �DR the Sloe Work Order��a�
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
eNV nAMAGE WHICH MAY BE INCURRED DUE TO THE DISCONNn CI'M NOP
st.cvDSD u..m� outulsta
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