HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASEPlanning -&(Development Services Department
Building & Code Regulations Division
2300 Virginia Avenue
• R D ASGAM Ft Pierce, FL 34982
OU� Phone: 772- 462-2165
. Fax: 772-462-2522
7,
1 Request for 30-Day Temporary Power Release
Date: 10eld . Permit Number: _/S06- d L/ l7
Project Address:
THE UNDERSIGNED HEREBY REQUEST
ABOVE DESCRIBED PROPERTY, FOR A
THE PURPOSE OF TESTING. SYSTEMS A
INSPECTION. INCONSIDERATION OF A
ACKNOWLEDGE AND AGREE AS FOLL(
1. This temporary power release is requested
of any type, other than that permitted by c
2. As witness by our signatures, we hereby ag
Building Division Policy, which is incorpor
3. All conditions and requirements listed in tl
4. Testing" have been fulfilled and the premi
5. All requests for an extension beyond 30 da,
for the request. Power may be removed fr
has not been approved within 30 days. A
WE HEREBY RELEASE ANDAGREE TO I
THEIR EMPLOYEES FROM ALL LIABILI'.
WHICH MAY ARISE NOW OR IN THE FM
ANY DAMAGE WHICH MAY BE INCURRI
ELECTRICAL POWER IN THE EVENT OF
OWNER SIGNATURE
/Z-
OF ELECTRICAL POWER TO THE
UOD NOT TO EXCEED THIRTY (30) DAYS, FOR
EQUIPMENT IN PREPARATION FOR FINAL
[,OVAL OF THE REQUEST WE` HEREBY
�r the above stated purpose only, and there will be no occupancy
struction during this time period.
e to abide by all terms and conditions of this agreement, including
ed herein by reference.
attached document entitled "Requirements for 30 Day Power for
is ready for compliance inspection.
must be made in writing to the Building Official stating the reason
n,the site and/or a Stop Work Order issued if the Final Inspection
e of $100.00 will be required to lift the Stop Work Order.
LD HARMLESS, ST. LUCIE COUNTY, AND
CS AND CLAIMS OF. ANY TYPE OF NATURE
RE OUT OF THIS TRANSACTION, INCLUDING
DUE TO THE DISCONNECTION OF
:OLATION OF THIS AGREEMENT.
DATE
`GENE N .TOR SIGNATURE i / E
1b9M
TUBE
SLCPDSD Revised 06/14/2010
Pe- OCT 08 2010
Lucie �°un�- fir�r,rDt