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ST LUCK Building & �ode Regulation Division
COUNTY2300 Virglr 1a Ave
• Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30--Day Ten-i,porary Power Release
Date _ j 0- a9 a Permit Number; _ a 103 -0133
Pro" Address:
r�ff UNDERSIGNED HEREBYREQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE Oc`SCRI9=p
PRt'►aFRTY, FOR A AERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING AND EQJIPMMENr IN PREPARATION FOR A FINAL INSPECTION. F ROD./SYSF TH
REQUEST V* HERBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
CONS O, APPRC��J:,L p� THE
'his tempor21' Power r,lease is requested for the above st3tel purpose oi,iy, and tyre v:,:l be Fm
Oc:upanc�, of any type, other than chat perrnitted by construction during this time per,w
As r�i:ness by our signatures, we hereby agree to abide by all term, and conditions of r►b; aS;eemenit,
viciucing &Wding Division policy, which is incorporated herein b-r reference.
4i' cep"d,tloes and requiremeri listed in the attacf
Po„er fo,, �ecl dncurnent entitled "R2gjirerrerofty
estir,c have been fulfilled and the prernise is ready for compliancc- inspet-tpn
Ali requests for an extension beyrnd 30 day, must be rnade in ,,biting to the Bu,ld,
ng ttF reascm far the request. Power rray be removed From the site and; o- a S. V1� O i l stagy e i
the Fr,61 Inspection has not beer, approved within 30 days. A fee Order �-'`' �
the StoP W3rk Order. of $100 Oi, will be requires; tc
VVE HEREBY RELEASE ARID AGREE TO HOLD HARMLESS, ST. LUCIE COUN TY, AND THEIR EMPLOYEES
A� L146ILITIES ANO CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE
OF THIS TRANSAM- CND INCLUDING ANY DAMAGE WHICH MAY BE E LorE. S Ft20fy
OISCONNE�('jN OF ELECTRICAL POWER IN THE EVENT OF VIOLATION
DUB TO THE
OUT
QLATIQN OF THIS AG4EENEN?'
2LK. SI;*NATURF /0- 2-8—i /
k
GEINERA,1. C0t,1TRArTpR SIGMA
ELECTRICAL CONTRACTOR
GATE
I0-a-7.aca'�
DATE