HomeMy WebLinkAbout30 Day Request Temporary Power ReleaseREQUEST FOR 30 BAY TEMPORARY !SOWER RELEASE
DATE: TE: /j S F. LUCTE COUNTY g.I LIDGG.. & ZONING
00
L4, AVE
FORT FIERCE, FL 34952-5652
PE, RMIT N AH ER.- Pia. (561) 2165
36a -- Q � p sr FAX (561) -1148
PROPERTY ADDRESS:
THE UNDERSIGNED HERERY REQUEST RELEASE OF ELECTRICAL POWER To
THE ABOVE DESCRIBED PROPERTY, FORA PERIOD NOT TO EXCE TY (30)
DAYS, FOR THE PURPOSE OF TESTING SYSTEMS AND EQMPMEN`R° IN
PREPARATION FOR FINAL :INSPECTION. IN CONSIDERATION OF APPROVAL OF
THE REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
1. This tmpomry power release in requested for the above stated purpose o*,
and there Will be DO occupancy of any type, other than that permitted by
Mstructlon during this time period.
2. As witness by our signatures, we hereby agrm to abide by all terms and
conditions of this agreemcatt including Auildia.g Division policy, whiffs is
incorporated hen by refeream
3. All conditions and requirements listed in the attached document entitled
"Requirements for 30 Day Power for Testing have been fulfilled and the
promises is ready for compliance inspection.
WE TTEREDY RELEASE AND AGREE TO HOLD HARN[LESS, ST LU'CIE COUNW,
AND TOTEM EMPLOYEES FROM ALL I EUTIES AND CL41MS OF ANY TYPE OF
NATURE WHICH MAY ACE' NOW OR IN THE FUTURE OUT OF THIS
TRANSACTION, INCLUDING ANY DAMAGES ih CH MAY DE INCURRED DATE TO
THE DISCONNECTION
ION OF ELECTRICAL POWERIN T' EYED VIOLATION IOLATION OF
X ZZtSS AG7.`CL'tAt` E�AEN ■ . 1
OWNER
,/,f(f
1-T-fz- E--
GENE CONTRACTOR SIGNATURE
ELECTRICAL CONTRACTOR SIGNATURE
RECEIVED OCT 022013