HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASEPlanning & Development Services
Building & Code Regulation Division
COUNTY2300Vrginia Ave
•_ k 1 0 k Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date- 1 Z - Z /- 20 Z ( Permit Number: Z / 03 - 0
Projw Address: S 4' Ste_ L c. a S
-ram---
THE UNDERSIGNED HERESY REQUEST RELEASE OF ELECTRICAL POWER TO Th:E ABOVE DESCRIaED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF .TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSQECTIOPI. IN COPISID_RATION Or APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS =OLLOWS
t This temporary pevnr reWs-- is requested to: the aboye stateJ putpose oily, and 11*Te wil be nh
occupancy of any type, other than that permI:ted by ron,truct,,3, t 1La+N IN-j lane period
2 As v um5s by our sugrartres, we hereby wren_ to abode b'y all term; and cundtGr jfrS of this agen'nent,
uOudutg Bolding Division Polw-y, rrhr_h is incorporated herein bi reterenr_e.
3 49 cord+tiors and requirements listed in the attarkied dxument eatie d '",nt enwnu fpr 3u Day
Power for Testing' have been fu(folled a .d the pier.+se is ready for corn 4iancE inspection
4 All requests for an extenseon beyond 30 days must be rnade Ln rmting to the ehlding Offioat stai.reg
the reason for the request_ Power may be remrrred from L+ke site a Stop Work Order issuied it
the Fv+al Inspection has not been approvea w'thin 30 days. A fee of $100 00 will be regLwed tG lh
tOe Stop Vvark Order -
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST LUCIE COUNl'f, AND THEIR €MPLOYEF-5 FRO'-1
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OJT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY aL INCUPP,ED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREE,%IENT
IGNATUq E
/Z - Z /- 2 a 2 /
DATE
Z'Z ( - ?02/
GENERAL CONTRACTO? SIGNATURE DATEE
ELECTRICAL CONTRACTOR SIGNATURE DATE