HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASE23
Planning & Del elopment Services Depa
Building & Code Regulations Dii
2300 Virginia Avenue
Ft Pierce, FL 34982
�s Phone: 772- 462-2165
BY i Fax:.772-462-2522
St Lucia Count,
Request for 3
Date:
Project Address: , `2-1)0
THE UNDERSIGNED HEREBY REQUEST REL
ABOVE DESCRIBED PROPERTY, FOR A PERT'
THE PURPOSE OF TESTING SYSTEMS AND E
INSPECTION. IN. CONSIDERATION OF APPRI
ACKNOWLEDGE AND AGREE AS FOLLOWS:
ST.
Day Temporary Power Release
Number: % 0 Ll0 I
SEP 19 2018
kSE OF ELECTRICAL POWER TO THE
D NOT TO EXCEED THIRTY (30) DAYS, FOR
UIPMENT IN PREPARATION FOR FINAL
VAL OF THE REQUEST WE HEREBY
1. This temporary power release is requested for t1 a above stated purpose only, and there will be no occupancy
of any type, other than that permitted by construction during this time period.
2. As witness by our signatures, we hereby agree tol abide by all terms and conditions of this agreement, including
Building Division Policy, which is incorporated >�erein by reference.
3. All conditions and requirements listed in the attached document entitled "Requirements for 30 Day Power for
4. Testing" have been fulfilled and the premise is reedy for compliance inspection.
5. All requests for an extension beyond 30 days must be made in writing to the Building Official stating the reason
for the request. Power may be removed from the site and/or a Stop Work Order issued if the Final Inspection
has not been approved within 30 days. A fee of $100.00 will be required to lift the Stop Work Order.
WE HEREBY- RELEASE AND AGREE TO HOLI
THEIR EMPLOYEES FROM ALL LIABILITIES
WHICH MAY ARISE NOW OR IN THE FUTUR]
ANY DAMAGE WHICH MAY BE INCURRED D
ELECTRICAL POWER IN VIE EVENT OF VIO
HARMLESS, ST. LUCIE COUNTY, AND
AND CLAIMS OF ANY TYPE OF NATURE
OUT OF THIS TRANSACTION, INCLUDING
E TO THE DISCONNECTION OF
TION OF THIS AGREEMENT.
M11vie
OWNER SIGNATURE DATE
� �rT
.TURF
SLCPDSD Revised 06/14/2010
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