HomeMy WebLinkAboutpower releaseSir. ,LrF
COUNTY
F 1 0 R( 0 A
Planniny & Development Seivices
Building & ICode Regulation [division
23�00 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30--Day Ten-iporary power Release
Date: _ ��s �a� _ Permit Number; _ _o? 0�- oaL4 9
Project Address:
S3 l�_._ �A M ��N•Q �Qll�
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE POURPOS THE OF T STING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION. E TESTING SYSTEMS
REQUEST WE HER,=BY ACKNOWLEDGE AND AGREE AS FOLLOWS:
N CONS 0- APPROVAL p� THE
! This temporar}, poryer release is requested for the above stdtel pu+pose only, and them Pi,•,be no
I
occupancy of any type, other than that permitted by construction dunng this time period.
As witness by our signatures, we hereby agree to abide by all terms and conditions of this agreement,
including Building Division policy, which is incorporated herein by reference.
3. 4li conditions and requirements listed in the attached dc-current entitled "Re jiremenls for 3;
Power for Destiny" have been fulfilled and the piernise is ready for compliance inspection 1 7oy
1 All requests for an extension beyond 30 days must be made in tritirtg to the Building pffical sta l-7�q_
(be reason for the request. Power may be removed from the site and!o; a Stop Worn Order isijei Ir
the Final Inspection has not been approved within 30 days. A fee of $ 100 tk) will be regLHre-, to !eft
the Stop U-ork Order.
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUN TY, AND THcIR EMPi_01
ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NON. OR IN THE F�
OF THIS TRANSAt Cry, INCLUDING ANY DAMAGE WHICH MAY 8E I FUTURE OUT
0[SCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION
DUE TO THE
E Ji'JR_ QL1T
CATION OF THIS Av4EENtEM'
SIGNATURE
GENERAL 2CONT;WTno
ELECTRICAL CONTRACTOR SIGNATURE
3 -1q-aa
DATE
2_ru '%"
v . _11 - v% war
3 ` 1/- 2022
DA rE "`--�----�