HomeMy WebLinkAbout2021-10-26 10-46_page_1Planning & Development Services
Building & Code Reyulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date' _ -10= �(o -_ Permit Number;
Project Address:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POW;:
R TO THE
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FORT E PURPOSEBOVE OF TEDSTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. IN CONSIDEP.ATION OF APPFtOVA OF: TFii
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
! This temN a:y power release is requested for the above stated r ; occupancy of any type, other than that perrnitted b Pu pose O11y, and there will he no
A, witness b Y construction during this time period.
y our signatures, Ire hereby agree to abide by ail term; and conditions of this agreement,
Including Building Division Policy, which is incorporated herein b� reference,
3. All conditions and requirements listed in the attached document entTeij "Req Iir cments for 30 I cy
Pourer for Testing- have been fulfilled and the premise is ready for compliance inspection.
11. Ali requests for an extension beyond 30 days must be made in writing to the Building Official statin
the reason far the request. POWer may be removed frortr the Final Inspection has not been approves! within 30 days rcA Ifeete ao�� f` a SlJ will or rOrdired to d
� ;�JorK Order Issued if
rtie Stop V,ark Order.
WEHEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST, LUCIE r..0UNi'r, AND TH"IR EMPLOYEES FR0r+1
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARc
SE NOW OR IN THOF THIS TRANSACTION INCLUDING ANY DAMAGE WHICH M
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOBLATION OFEH IS A R THEE FUTURE OUT
AGREEMENT
t ' ti ER StGrIATURE
DATE '_`-----------
GENERAL COr1TRACTOR SIGIIATURE
DATE ---
ELECTRI CONTRACTOR ONTRACTOR SIGNATIJRE
DATE