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HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASEi'lannin & Development Services Building & Code Regulation Division 2306 Vilr Wia,A' e Fort Pier' e, FL 349_82 772-462�2165 Fax 772-462-6443 Bequest for 30-Day Date: --�-IS Project Address: _� ;2 THE UNDERSIGNED HEREBY REQUEST RELEASE OF PROPERTY, FOR A PERIOD NOT TO EXCEED THIRT) AND EQUIPtIENT IN PREPARATION FOR A FINAL IN REQUEST WE HEREBY ACKNOWLEDGE AND AGREE , 1. This tempora:y.power releas_ is requested to; occupancy of any type, other than that perirnit 2. As witness by our signatures, ,,,e hereby a;rp including Bulling Division Policy, which is incur 3. tdl conditiors and requirements listed in the att, Power for Testincl" have been fulfilled and the p 9. all requests Far an extension beyond 30 dZ)ys m the reason for the request. Power rear be remc the Final Inspection has not been approved with the St©P V,ark Order. WE HEREBY RELEASE AND AGREE TO HOLD HARMLES: -ALL LIABILITIES AND-CL:AINIS OF ANY TYPE OF NATUR OF THIS TRANSACTION, INCLUDING ANY DAMAGE WH DISCONNECTION OF ELECTRICAL POWER IN THE EVER SIGNATURE GENERAL CONTRACTOR SIGNATURE ELECTRICAL SIGNATURE emporary Power Release Permit Number: _2 Zd Z — Q j *fo Lti- I tZ[CAL POWER TO THE ABOVE DcSCR1BED 30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS EMON1, IN CONSIDEPATION OF APPRO' VA OP THE FOLLOWS: ' above stated Purpose only, and there will be no by construction during this time period. abide by all term; and conditions of this agreement, rated herein by reference. ;ed document entit!cj "R2q•�iremrnls for 30 ,7dy liise is ready for complOnce inspection. be rnade in ,tinting to the Bwldino Gffcial 5tatir?y d from the site. and!c, a St0 Work Order isue d if 30 days. A fee of $ lOG (+.) will be required to !:Ft ST. LUCI€ GOON-Pf,-AIND THEIR EMPI OWEES FR,Ot4 WHICH MAY ARISE NOW OR IN THE FUTURE OUT :H P,1AY BE INCURRED DUE TO THE OF VIOLATION OF THIS AG REEIti9ENT ((ISZ2 DAT 11 - l! !� 2 7d I -' 11 lS-2Z DAT