HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASEPlanning & Development Services Department
MNNLp -nilding & Code Regulations Division
2300 Virginia Aveeeue
>>'; ' �::•M<•:.1 ; ; • :,oc' 4�� pBy Ft Pierce, FL 34952
iY�:�o�� Phone: 772- 462-216 i
' pax: 77a-462-2522
]request. for 30-Day Temporary Fovea• Release
i]ate:''�rQj
Permit Number:
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Project Address:
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THE UNDERSIGNED HEREBY, REQUEST RELEASE Or, ELECTRICAL POWER TO THE
ABOVE DESCRIBED FROPIER'T•Y, FOR A PERIOD NOT TO EXCEL, D THIRTY (30) DAYS, FOR
THE PURPOSE OF g + STINC SYSTEMS AND EQUIPMENT IN P PARA'ITION FOR FINAL
INSPECTION. IN CONSIDERATION OF APPROVAL OF THE R'QUEST WE HEREBY
ACKNOWLEDGE AND AGREE AS FOLLOWS:
L , This temporary power release is requestcd for the above Stated purpose only, and there will be no occupancy
of any type, other than that permitted by construction dur;rtg this time period.
2. As witness by our signatures, wm hereby agree to abide by all terms and conditions of taxis agreement, including
,Fiullding Division Policy, which is incorporated herein by reference.
3, All conditions and requiremcnts listed its the attached documexrt entitied "Requircmeats for 30 Day Power for
4. Testifig" have been fulfilled and the premise is ready for compliance inspectioxl.
S. All requests for an extension beyond 30 days must be made in writing to the Building Of�ci�rl'stating the reason
for the request_ Power maj, be removed from .the site and/or a Stop Work -Order issued if tho k'1d%7'fmspeetlon
has not been approved within 3Q days. A fee of S100.00 will be required to lift the Stop Works Order.
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, INCLtUIDING
ANY DAMAGE W ICH MAY BE INCUM..REJfD DUE TO THE DISCONNECTION OF
ELECTMCAL POWER IN THE EVENT OF VIOLATION OF THIS ACREEM)ENT.
OWNER SIGNA
GENERAL
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TOR SIGNATURE
SIGNATURE
DATE
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DAT
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$L('PD$D Revised 06/14/2010
RECEIVED FEB=2 7 2015