HomeMy WebLinkAboutScan_0010.pdf-.' LUCIL
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trnportant: The occupant of the property (or other appropriate party) shall have made proper
application to the electric utility, paid any applicable fees or deposits, and requested power in a
timely and informed manner. St Lucie County is not reNponsible for any delays in the receipt or
electric power.
We acknowledge and accept the terms of this permission. We further acknowledge that violation
ofthis agreement or a finding ofurisale conditions and/or practices found on the site or occupancy
of the site may result in intrnediatc disconnection of this temporary power without warning and
hereby release St Lucie County and all representatives of any and all liability resulting frorn us not
abiding with this agreement.
Ptinl yRtmc l ctri"i Contractor Company Name
Signature -Electrical Cuntractur ' Date at�uree - caner Date
e_ C
Print Namc - Electrical Contractor Print Name - Owner
Phone Number- floc triral Contraglor Phone Number - Owner
Liccn,w # Elcclric:al Contractor
Signature - Prime Contractor Date
Prior Naive - Pri e�ontractur
r -
License -y Prime Contract&
Approved for St. Lucie County by:
Print Name - Prime Contractor Company Narmc
Phone Number - Prime Contractor
r
Signature - Electrical Inspector/BO lnsp iU # Datc
lnspcctar comments, lirnivitiamt and restrictions:
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