HomeMy WebLinkAboutTEMPORARY 30 DAY POWER RELEASEPlanning & Development Services
Building &.Code Regulation Division
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30 — Day temporary Power Release
Date: 9%) 9 1 1 3
Property Address: D-S 3®
Permit Number: _ _13o l— Q ow
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED PROPERTY,
FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS AND EQUIPMENTS
IN PREPARATION FOR FINAL INSPECTION. IN CONSIDEIRATION OF APPROVA.L.OF THE REQUEST WE HEREBY
ACKNOWLEGE AND AGREE AS FOLLOWS: i
1. This temporary power release is requested for -
occupancy of any type, other than that permitt
2. As witness by our signatures, we hereby agree
including Building Division Policy, which is incor
3. All conditions and requirements listed in the at
Power for Testing" have been fulfilled and the 1
4. All requests for an extension beyond 30 days m
the reason for the request. Power may be remi
the Final Inspection has not been approved wit
Stop Work Order,
above state purpose only, and there will be no
by construction during this time period.
abide by all terms and conditions of this agreement,
crated herein by reference.
fled document entitled "Requirements for 30 Day
mise is ready for compliance Inspection.
t be made -in writing to the Building Official stating
ad from the site and/or a Stop Work Order issued if
130 days. A fee of $100 will be required to lift the
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, �T LUCIE COUNTY, .AND THEIR EMPLOYEES FROM ALL -
LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT OF THIS
TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE .INCURRED DUE TO THE DISCONNECTION
ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THI$ AGREEMENT.
OWNER SIGNATURE I DATE
GENERAL CO AC R SIGNATURE I DATE
ELEC AL 069TRACTOR SIGNATURE II DATE
RECEIVED SF° 18