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UST LU-cjE Building A,Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Permit Number: _ a of a —C)j q Q
"-iE L+%JEhS:GNEC HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE D=SCRI3:D
PhOP.+�'?'. FOR A PEZOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF Tc5TING S•iSTEN IS
A'�� EQJIZ'MEN` IN PREZ).A.RATION FOR A FINAL INSPECTION. IN CONSIDERATION 0= ASPPRCWAL OF THE
REQLi-5— WE HERF6Y ACK"410WLEDGE AND AGREE AS FOLLOWS:
'tiffs tent�� a1- POINT l release, is requested foi the above stated purpose oljiy, and there v.,:l De ),t,
occuaency of any type other than that permitted by constructlon during this umz per,rid
tt Wi;N—ES Qy our signatures, we hereby agree to abide by all term; and conditions of -'Oils acreernent.
"Ic+udlnc Sullying D!wsion Policy, which is incorporated herein by reference.
t.i. xr!dG1orS and requirements listed in the attached docurnerit entit!ed "Regjirernenu Fur 3C ;)aj
Powe, `or -e-Sting" have been fulfilled and the premise is ready for comPlOnce inspeut,on
41; -equESU for an extension beyond 30 days must be made in venting to the Budd, left t
tt,F reasm for the request. Power may be removed from the site an�i,or a Stop Y1 �+rde�,s:e',t
th* Fir,ol Insaection has not been approved within 30 days. A fee of � loo 00 will taz req_nreC �. rt
"'e Stop V1-ark Order.
VVE -iFR_3Y RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AVD THEIR EMP_C)YE.S :R Jri
A--tL i-IAEILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE F 1T' r
Or HIS TRANSACTION, INCLUDING, ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE �R CJT
0lS�ONNcCTIO"4 OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEN1E1 r
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