HomeMy WebLinkAbout30 day powe releaseS �T..L t1cl -�
COUNTY
F 1 0 R 1 0 A" ,
Planning & Development Services
Building & Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date' --q -��J- o� 0� _ Permit Number: _ :2 / O 2, —
Project Address:
THE UNDERSIGNED HEREBY REQUEST RELEASE G= ELECTRICAL POW;:;K TO Tt•ir- ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30 j DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL I%SPECTIC% IN CO`iSIO=RATION OF APPROVAL OP rl-IE=
REQUEST WE HEREBY ACKNOWLEDGE A1J0 AGREE A; =0;LOV6
This tempora'V pov/el release I; I! �;; ',�� n`.^.r S'Jlof � �:��.• oll'y, afIiI (eery wlil be rIJ
occupancy of rwr type, other man era,t .^.-e r - .tP,l t. r thi, time Period
As Witness try our signatwF,,, We horPUJ, .?s•r+• tr.: Ater *e, t), all ter-1; Jr.Q rr)l.d�t r)n� of (hli Ayrtement,
including Building Division Pohcy, wh✓.r, rS if t'r rlr�"trK.0
All conditions and icqulra_nlen' Irsttd ,r, vio.- e'te r.•-J I en(Jled 'P.crl_urerricriLs fjr 30 Day
Power for Testing" have besrn lu11-1,Fd 11r p r,t •.r• e tc tit Oo, Inspection.
All requests for an Prtension tr--yon9 3C rm,- Ix- io We Building Of(ir.idl st,iting
the reason for the reduest Pov%er r %i, to •ft,,c.rc It:A, t+•, wv en;'o• a Styr Work OriJer tweed if
the Final Inspection has not beef', anvrrot vi l+•,^ 30 da,� It(- of $100 (X) will be re(juired to lift
the Stop Work Order,
WE HEREBY RELEASE AND AGREE TO HOLD HARYILt SS, ST LUCIE coijrl Fr, AND THEIR EMPLOYEES FRCi)f4
ALL LIABILITIES AND CLAIMS OF ANY T)'Pc OF NATUkc WHICH MAY APJSE NOIN nP. IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCUP.REU DUE TO THE
OISC:ONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT
c "VNEP, SIGNATURr DATE
4:T--/Y-- 2621
GENERAL C01JRACTOR SIGNATURE DATE3 - - 2a 2 _
ELECTRICAL CONTRACTOR SIGNATtURE DATE �y�