HomeMy WebLinkAbout30 day temp power release formAT Planning & Development Services
Building &,Code Regulation Division
2300 Virginia Ave
' A Fort Piercer FL 34982
772-462-2165 Fax 772-462.6443
Request for 30-Day Temporary Power Release
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Pro)ect Address
1",1E ONDERSIGNEO HEPEB-- REQUEST RELEASE OF ELE-7WCAL POINER TO THE A8,0VE DtSCrtI3=J
KOPEK 71Y, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF ES'ING 5 rSTEMS
AND EQUIPMENT I PREPARATION FOR A F TNAL INSOC•' ON. IN C0"15I[j T10V s;� k:�rk;r'rJ= T :F
REti�IEST L"�c HER --BY ACKNOWLEDGE AND AGREE AS %LLOWS
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'Y;G HER= `� RELEASE A%0 AGREE TO HOLD HARMLBS, Sr LUCIE COUNT-r. A'49 T"EIR FMP_t�rE��
. -L LIABILITIES ANU rLA?'-IS OF ANY TYPE OF NA7UkE WHICH MAC AFI<� NO.V OR IN THE CJTJ'AE r;UT
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UISCONNECT10% Or ELECTRICAL POWER IN THE EVENT OF VIOLATIOPi OF THIS AGR; E' EN"
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