HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASER*q4ek-for.
Date:' /Ax),
Project -Address-.
M411CQ 010d d
AR
WW"'14 V6,1160men ervi
WA- Ave..
-461�2US FaX 772-462-6443
T e M Obiaryftwer Adh6ase
Pemit'NombeAq 0\—\ —
THE UNDERSIGNEO HEREBY REQUEST- RkFA-SE OF ELEMICAL POWER To THE ABoVE
PROPERTY, FOR A PERIOD NOT'TQ M�El) THIRTY (30) PAYS, FOR THE PURPOSE OF-1
AND EQUIPMENT IN PREPARATIC ' N FOR kHNAL-.INSP.E - MON. IN CONMERKRON OF,
.UFiTW,B'HEREBYA M" 0WLEDMADA80XE-A�FbLLows-,
I. 7his temporary power release is. Mi'mLM lbr the abo*� sliftd P�r� only, and #m W
occupancy of any type, *1#er thaA that Pemlided by cohstruction during this tirno Mod.
2. As vvitnm by our �i . Pe
_q.naW0qs, we herebyagrigg to *i0e by -all t�rms and conditions of this i
indUdHig Suildin§ bivl!flon Pbky', �*Fich is incorporaied Mtefin by, re%rence.
3. All conditions and requirerfientrx I . ia�d in the atlh0ed document entil1ed �Requlrem.ents f6r
Powee fbr Teo�gr We"bMn'fulfi'led'and the prern- ise is ready for,compliance inspeclJon.
.4. A-11 rtquests forian aderiew beyond 30 days must be-.rrade in writing to the Su'Ildingofficl;
the reat:on* fbr the requesL PdWe�i m* be removedfrorn the site aridler a- Stop Work. Orde
the Final 1*dcton has not be*en'IPProved Within .30 -days. A fee of $100.00 will be requir
the Stop Work Order.
WE MEV RELEASE AND AGREE To HOLD HARMLE�S, ST. LUM COUNTY, AND THEIR EMP
ALL LIABIUMS AND -CLAIMS'
OF My TYPP. OFNATURE 'WHICH MAY A.PiSE- NOW OR IN 7H E
OF NSAMON, XKLUPING AN`Y'QAMAGEWi4JQH-.MAy BE INCUR
I RED DUE To THE
DISWNNEMON OF ELEMICAL POWER �IN TW EVENT OFMOLMON OF THM AGREEMEN
DATE
DATE
DATE'
Ji", 'J
"T It
- I A. � , . � A-1; . _: km , I � * � I � I - V � ', � M,
qG SYSTEMS
)VAL OF!:THE
�e no
Bement,;:,
Day
'stafing -
issued if
d to lift
MEES MOM
;UTURE 6UT
FEB 2 12019
Permitting Department
St. Lucie County, FL
LR-J L000A000d ZU-i J999L8L8ZLL
_WMA L L: L L 6 L I- 2_30