HomeMy WebLinkAboutBuchanan 30 day meter form_20211007_0001OWNER
CO.UNTY
Planning & Development Services
Building &Code RegulaUon Division
23OO Virginia Ave
Fort Piere, FL:14982
772-462-2165 Fax772-462-6443
uest for 3O-Day Temporary Power Release
Date ak*-colg
Project Address:b
THE UNDERSIGNED H REQUEST RELEASE OF ELECTRICAL FOWER TO .IHE ABOVE DESCRIBED
PROPERTY. FOR A PE D NOT TO EXCEED THiRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYS]EMS
AND EQUIPMENT IN P
REQUEST WE HEREBY
ARATION FOR A FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE
NOWLEDGE AND AGREE AS FOLLOWS:
l. This power release is requested for the above slated purpose only, and there will be no
occupancy any type. other ttan that permitted by construction during this time period.
2. As witness our signatures, we hereby agree to abide by all terms and conditions of this agr€ement,
including Bul dlng Dtuldon Pollcy, which is lnmrporated herein by rcference.
3. Allconditiofl and requirdmmts listed in the atbched doe,ment entided "Reguirements for 30 Day
Power for 9"have been fulfilled and the premise is ready for compliarrce inspection.
4. All requests extension beyond 30 days must be ma'de in writing to the Building Official sEting
the reason the r€quest. Polver may be removed from the site and/or a Stop Work Order is$.ted if
the Final Ins has not been approved within 30 days. A fee of $100.00 will be required to lift
the Stop Order.
WE HEREBY RELEASE
ALL LI,ABIUTIES AND
AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROM
OF ANY TYPE OF NATURE wlIIC}I MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS . INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
POWER IN THE EVET{T OF VIOLATI OF THIS AGREEMENT.
DATE
DATE
EI."ECTRICAL @ URE DATE
F L:O R I D Fr
Permit Number:
an
DISCONNECNON OF
'I