HomeMy WebLinkAbout2021-09-29 07-50_page_1.pdfPlanning & Development Services
ST. LUCK Building & Code Regulation Division
.I
• 2300 Virginia Ave
•_ ' I D A Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Terrliporary Power Release
Date' =a _ Permit Number: _ _a ()
Project Address: �� > � ,.,,1 A ►� Q,Nec� el (y �� --- ---
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DcSCRI3ED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF Ti_STING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDEP.ATION OF µarF.i)+fn` OF: THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
i his temporary power releasf is requested for the above stated purpose oriy, and there vt,
occupancy of any type, other than that permitted by construction during this rime per,
As witness by our signatures, we hereby agree to abide by all term; and conditions of tnis acre=-ment,
including Building Division Policy, which is incorporated herein by reference.
All conditions and requirertienis listed in the attached document entit!ed "Req.rirernenl_s fJ, .3i, ^ay
Power `or Testing" have been fulfilled and the premise is ready for compliance inspecticn
Ali requests for an extension beyond 30 days must be rnade in wTitincg to the Budding Cffioa' s'a;
the reason for the request. Power maybe removed from tf e site and! - a S;op Vio-; Ord,-,,,•, �;-,;
the Firral Inspection has not been approved within 30 days. A fee of 3100 OC will to re4_r__ ;c
the Stop Nark Order.
USE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUC.IE CC LJNT'>, .AND THEIR EM=:_EL_
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAYARISE NOW OR IN THE c,,rTJ..R= C'.,!T
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DU- TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AC.REE\IEN-
DATE
GENERAL CONTPACT0 SIGfNAT1JRE 04TE Y
ELECTRICAL CONTRACTOR SIGNATURE �~ r�+ ~DATE ���