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Building & �Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Date: _ �3 1 aDaa, _ Permit Number: 1010-039 O
Project Address: S31 N
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 INSPECTION, IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HERE -BY ACKNOWLEDGE AND AGREE AS FOLLOWS:
! This temporary power releas-- is requested for the above stated purpose only, and there will be no
occupancy of any type, other than that permitted by construction during this time period.
As witness by our signatures, we hereby a;ree to abide by all terms and conditions of this agreement,
rncludinq Building Division Policy, which is incorporated herein by reference.
3. 411 conditions and requirements listed in the attached document entitled "Requirements for 31) Day
Power `or Testing" have been fulfilled and the premise is ready for compliance inspection.
4. Ali requests for an eytension beyond 30 dOys must be made in 'trriting to the Building Official stating
the reason for the request. Power may be removed from the site and/or a Stop Work Order issued if
the Final Inspection has not been approved within 30 days. A fee of $ 100 (X) will be required to !eft
the Stop V.ork Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTf, AND THEIR EMPLOYEES FRCitd
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF THIS TRANSACTICN, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT
SIGNATURE
2 _2
DATE
-21
GENERAL COfJ7PACTOR SIGNATURE —w�� DATE
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ELECTRICAL CONTRACTOR SIGNATURE W UATF w"� "