HomeMy WebLinkAboutpower releasePlanning & Development Services
Building & Code Regulfition Division
2300 Virginia Ave
R Fort Pierce, FL 34982
772-462-2165 Fax -
ax 772-462 6443
Request for30-Day Temporary Power Release
Date: ) 1 p a s
Project Address: �J
- O q Permit Number; e Ai �I
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THE UNDERSIGNED HEREBY REQUEST PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (3p)
RELEASE OF ELECTRICAL POW_
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTIONPOWER TO THE ABOVE DESCRIBED
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLO DAYS, FOR THE Pi1R TIO OF TESTING SYSTEMS
IN CONSIDERATION OF APPROVAL OF THE
1, —INS W5:
temporary power release is regUes-ted for the above stated
acupancy of any type, other than that permitted b
z' As wRneSs by our stgnatureS, w Purpose only, and there Will be no
including Building e hereby agree to abideby
during this time period.
g Division Policy Y y all terms a
3. All conditions and requirements�' whsch is incorporated and conditions of this agreement,
Powo, fw T listed in the attach herein by reference,
Testing- been fulfilled and the premedSe is ready clolm�liance ins
4. All requests for an liance "Requirements for 30 pay.
ire reason for the extension beyond days must be made in uniting to the Buildin
request. Power may be removed from the site and/or a Stop pecti ffl
the Final Inspection has not been a g Official stating
fr`e Stop Work Order. approved within 30 days. A fee of 3100.00 Will rork equired issued to lift
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NO
OF THIS TRANSA COUNTY, AND THEIR EMPLOYEES FRCIP�1
CTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
FUTURE OUT
DISCONNECTiOti OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THI' S AGREEMENT.
`r�GNATURE u ��
l DATE
GENERAL CONTRACTOR SIGNATUPE a a
ELECTRICAL CONTRACTOR SIGNATURES apt
DATE