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STIUCK Building R Code Regulation Division
,�COUNTY 2300 Virginia Ave
• Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Permit Number: c� ) 0' ' O
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f ; olect Address _ Sy C'�_ ► �! J N e ��J I --
�c HERESY REQUEST RELEASE Or ELECTRICAL POWEP TO THE A50VE D_SCPJBEO
PnO. E+ --Y, FO!, A PERIOD NOT TO EMCEED THIRTY (30) DAYS, FOR THE PURPOSE OF 7ES i ING SYSTENtS
��� E�JI?MEN IN P,REP4:ZATION FOR A FINAL INSPECTION. IN COfVSID_F_A TIO,, 4 Har};O'l.!, pF: TLiE
t%T HE; -St` ACKNOWLEDGE AND AGREE AS FOLLOWS:
-',is temcxra-� po:ver r_leas= is requested for the above stated purpose on y, and tl;e:e v,, 1 tW no
o ccpanc7 of an,, type, other than chat perrnr;ted by i onstructron luring this time pe-,C i
v%.Tress by our signaturES, we hlereby d;rpe to abide by all terra, and conditions of ,n:i aG'e.- ".eat.
i-:ciuoin_ Building D vision Policy, whi--h is incorporated herein by reference.
4j :o-dr;,o^s 2,1d requrremens listed in the attached dc-curnent entit'aj "Raquiremer'irs f j.
Powe- `or 'E-stinc-" have been fulfilled and the premise is ready for compliance inspe� cn
i,l;-equesu for an extension beyond 30 dz)y5 mast be Made m Vmting to the Buildrnc Cr=fiCa' star
(fie rEason for the request. Po.ti'er rray be renloved From the site and'G" a szt-,p ��+Ors Cfrj'r 'S�:'=t' r
t`i, Firnol Inspectio,i has not beer approved wthin 30 days. A fee of 3100 00 will re:_ re- .`
-e Stop bVrark Or(jer.
`✓VE HERBY RELEASE AND AGREE TO HOLD HARMLESS ST. LUCIE COUNFf, ANC) THEIR EfK-_C�iE-S FRz�t
A L `IA.EILITTES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAti ARJSE NOW OR IN THE F JTJR= G,!T
O� -IIS 'PA'vSACTICN, INCLUDING ANY DAMAGF WHICH MAY BE INCURRED DUE TO THE
OISCOt.N_C�IG"� OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS A"-REE*,rEi%—
- DATE
1.L C0'+'TPACT0P SIG'jAT1Jp(. DATE V�
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