HomeMy WebLinkAboutpower releaseCOUNT'
F L 0 R 1 D A'
Planning St Development Seivices
Building & Code Requlation Division
2300 VirgiX Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772.462-6443
Request for 30-Day Temporary Power Release
Permit Number: _-2 / UL�� _ 03 Z /
P`:leci AJkj� -ess � C► d J T-
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-'-i:RE84 REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE D=SCRI9ED
cOh t, PERI00 NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
:-ZEz:A.kATION FOR A FINAL INSpEMON. IN r.0"IS(D=PATiOv (;= µDrROVAL Or- TFiF
„- %,.E HE;=EY ACKNOWLEDGE AND AGREE AS FOLLOWS:
-`is teriM,2-1 tYJ .fit-'I@L5= li Iegjested fa the abo-e stated purpoie ooq, and there v,, ! De -,u
an, typ?, ocher r!ran chat permitted by ronstruct,on duriq this tome Period
:4 ty oL- s gnattor<<, rte rereby a, -e to abide by al! term, and cordraons of rh; as -extent,
g,,,;r� ng 0:vcs,on Policy, whv- is in,:Grporated herein b� reference.
4, :.c-d,: ori an:^ iegwtemen's listed in the attar-►,ed de{ument entitled'Regxrrm2r►ts Tu, 3-1 7)61
;3,uve- `or-esi+n�--" have tieer fulfilled and the pfemis_ is ready for comg6ance tnsfi•?cten
. -eavEst� for a-i e:tensoon beyond 30 days must be made in vrfrtfng to the Building GFfroa; sra. -
(},e rea51-ir, rl the reou cit Power fray he rentoved front tfe site and'o- a Stop Wark Ord-'r SiJ_l •:
+s,,e �r,�l !r5pect,o,1 has no! been approved ►vthin 30 days. A feu' or $100 Or) will bie ,c r r'
—E Stop ►' aft Of4E!
{ RELEASE AND AGREE TO HOLD HARMLESS, ST LUCIE couN rr, W40 THEIR EMP:UYEES r%.J
�.L LIt-=.-1T!ES AND C LAIIIIS OF ANY TYPE OF NATURE WHICH MAV ARISE NOW OR IN THE c T,ARE -JT
-,i_-PANSfMC-14, INCLUDING Aw DM4AGF WHICH MAY BE INCURRED DUE TO THE
DIS-0?.lcCT1T0'. OF ELECTRICAL POWER IN THE EVENT OF VIOLATION Of- THIS AGgEEN1EfY`
-2 2.
RATE
2-2Z-
GE'9;?iht ( O!JPAC r� )P SIGNATURE 04TE
7 21-22
ELECTRICAL CONITPACT( k- 51'JNATURE DAZE