HomeMy WebLinkAboutTemporary Power Release Form 09-22-'21 10:07 FROM 7728787656 T-541 P0001/0001 F-249
Pl nae>r�g.. Dev opment So ices
. 13 ' Id".9 Code ke ulation bivis!on
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230 :Ir-9 is Ave.
Fort`Pieiree;.�1: 3�952
772-"Z-i1-65 Fax 772-462-6443
Requei*for 30-Day'e emporary'Povwer Release
Date: Permit MOrriber:
Prqect Address, ��.��.
THE UNDERSIGNED HEREBY.REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY,FOR A PERIOD NOT TO EXCEED-THM Y(30)-DAYS, FOR THE PURPOSE OF-TESTING SYSTEMS
AND EQUIPMENT IN PREPARAM— N FOR A FINAL-INSPE=- N. IN CONSIDERATION OF APPROVAL OF THE
REQUEFr WE-HEREBY ACKNOWLMGE AND AGkEE AS MLLOi11fS:
1. ?his tax7Wwy power release is requested for the above stated purpose only,and the wall be no
occupancy of any We,other than.that.pemtiitted by construction during this lime period.
2. As witness by our signatures,we heMby.agree to abide by all terms and conditions of this agreement,
Including Building DiiAsion Policy,which is incorporated herein by reference.
3. All Conditions and requirements r*ted in the attached document entitled"Requirements for 30 Day
Power for Testing"have been'fulfilled and the premise is ready for compliance inspeciion.
4. All requests for an exbzansion beyond 30 days must be%made in writing to the Building Widal stating
the reason for the request Popvei-may,be removed from the site and/or a bop Work Order issued if
the Finaf Irispection has not been approved within 30 days. A fee of$I00.00 will be required to'lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS,-ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROM
ALL Lt4M LTTIES AND:CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICKMAY BE INCURRED DUE TO THE
DivS NNEMoN OF ELECTRICAL POWER n9 THE EVEN''OF VIOLATION OF TKS AGPZEMEW.
OWNER SIGNATURE URIC
fOi�"ri2AC�OLt DATTE
ELECTRICAL CONTRACTOR SIGNATURE DATE