HomeMy WebLinkAboutTemporary power release form, 30 day 11-18- 21 16:18 FROM- 7728787656 T-771 P0001 J0002 F-520
PlainnIfig .& I?ew liopment Services.
13U, alh $L ode RieOUl�ltion Division
2166-V :'!a Ave
far Pieiresr FL•32
772-4,62-2165 Fax•772-462-6443
lteglt fir 3E1=day'der rp.pra, Release
Perrrlit Wimber.
Project Addle;s: 4
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.INSPECITDN., IN CONSIDWTION OF APPROVAL OF THE
REQUEST"WE HERMY ACKNOVWZDGE ACID AGREE AS FOLLOWS:
1. This temporary power release is requested for the above slated purpose mly,and tte will be no
dccupancy of any type,other-than that perrrirtted-by coh ruction during this time period:
2. As witness by our signatures,we hereby agree to abide by all terms and conditions of this agreement,
Includittg Building Division Polity,which is incorporated herein by reference.
3. All conditions and requirement-,Iisttdd in we attached document entitled-Requirements for 30 Day
Power for Testinr have been'fuH"iiied and the premise is ready for compliance inspection.
4. All requests for an extension beyond 30 days must be.•rnade in writing to the Building .Official sbt9ng .
the reason'for the request. Power may be remotred''from.the site and/or.a Stop Work Order issued if
the Fmai•Insx on has not been approved within 30-days. A fee of$100.00 will be required bo lift
the Stop Work Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST,LUC[E COUNTY,AND THEIR EMPLOYEES FROM
ALL t.IABUXrLES AND.CLAIMS OF ANY TYPE nF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE'1fF H-MAY BE INCURRED DUE TO THE .
DISCONNECTION OF•ELECMICAL POWER IN TWE BIENT OF VIOLATION OF THIS AGREEMEW,
OWNER SIGNATURE DATE
DATA`
FiF- RICAL COWMCPOR SIGNATURE DATE