HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASESCANNED
# 'BY c /�
St Lucie coon-tv c
Development ServicesBuildin
-� o
logo
2390 Virginia Ave rJ a°
FOrt Pierce, FL 34982 �
772- r— ro
2-2165 Fax 772-462-64 �
Request for
Date: l(G/ 61r—
Project Address:
Temp®rraFY Power Release
Permit Number:
THE UNDERSIGNED HEREBY REQUEST RELEASE1 OF ELECTRICAL POWER TO THE ABOVE DESCRIBED
PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS
AND EQUIPMENT IN PREPARATION FOR A FINAL INSPECTION, IN CONSIDERATION OF APPROVAL OF THE
REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS:
I. This temporary power release is requested for the above stated Purpose
occupancy of any type, other than that perjmitted by construction during this time periodwill be no
2. As witness by our signatures, we hereby agree to abide by all terms and conditions of this agreement,
including Building Division Policy, which is Incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled "Requirements for 30 Day
Power for Testing" have been fulfilled and the premise is ready for compliance inspection.
4. 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 the Stop Work Order. 30 days. A fee of $100.00 will be required to lift
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. 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 1WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
OW
otVlvll I VKt
CONTRACTOR SIGNATURE
DATE
G'/ /4
DATE '
DATE