HomeMy WebLinkAbout30 DAYS TEMPORARY POWER RELEASEPl
81
77:
Request for
Date' ____UbSAz —
Project Address: s_o; Q
Wing & De . elopment Semi
tQs
ling & Code Regulation Division
1 VirgiX Ave
Pierce, FL 34982
462-2165 Fax 772-462-6443
Day Temporary Power Release
Permit Number:
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER ESCPJ
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF T� SYSTEMS
TING
BED
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTI � A
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWSfN C.0^JSIDERATION OF APPRCjJHL O� TFiF..
1 This tempora:�, Por✓er releas_ is reques
occupancy of any type, other than that
2. As witness try our signatures, v-e rereb,
including Building Division Policy, N4hkh
3. All conditions and requirement; listed in
Power for Testing" have been fulfilled ar
4. All requesLS for an extension beyond 30
the reason far the request. Power rray I
the Final Inspection has not been approt
the Stop'Aark Order.
!d for the above stated Purpose Oniy, and there will be no
errnrtted by construction during this time period.
c . -P— to abide by all term; and conditions Of this agreement,
incorporated herein b•i reference,
heatta&Fed doCLimerit entit!ej "Requirements for 30 pay
the Premise is ready for cornplOnce inspection.
oys mist be rnade to 'r/rrting to the Burldino Official stating
removed from the site. and,ror a S,,_y vVOrK'Order Issued, it
d within 30 days. A fee of l00 Lt) will be required tc, I;h
V/E HEREB`( RELEASE AND AGREE TO HOLD HART (LESS, S-T. LUCIE- COUN-P�,-AND THEIR--EMP� r
ALL- LIABIL]TTES AlVU CLAFMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT
OF TFIIS TRANSArTION, INCLUDING ANY DAMAG _ WHICH tIA'Y BE INCURRED DUE TO THE OUT
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT
SIGNATURE
GENERAL C0fgTRAr_TOR SIGfATURE
ELECTRICAL CONTRACTOR SIGlVAT1JRE
DAT
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DA/ (14h 2I