HomeMy WebLinkAbout2021-09-29 08-10_page_1.pdfST. LU+C'l-E
COUNTY
F l O R I D A
Planning & Development Services
Building & Code Regulation Division
2300 Virgir�ia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for- 30.-Day Temporary Power, Release
Date-
Permit Number: _ c1 Oa_O 1 a•�
Project Addre5s: S 1
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIME ATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
! This temporary- power, releasy is requested for the above stated Purpose only, and there wia be no
occupancy of any type, other than that permitted by construction dunn3 this time period,
�. As witness by our signatures, we hereby anree to abide by all term; and conditions of this agreement,
including Building Division Policy, which is incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled "Requiremems for 30 Day
Power for Testing have been fulfilled and the piemise is ready for compliance inspection.
-1. All requests for an extension beyond 30 days must be made in Writing to the Budding Official sta,,M7
the reason for the request. Power may be removed from the site. and;,or a S, or Order issu_ci it
the rrr,al Inspection has not been approved within 30 days. A fee of glOU.a) will be rOrd rzr; tc !u`t
the Stop bark Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUN IY, AND THEIR EMPLOYEES FRCr''1
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH M.AY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT
SIGrJATuR�;
k
DATE
1)-')->
GENERAL COtiTPACTOP, SIGNATURE ___------- j
LATE
ELECTRI�L CONTRACTQR SIGNATURE
DA TE