HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASE`1
IT („ y� t 'M` IT Planning & Development Services Department
Building & Cote Regulations I)ivisioln
# 2300 Virginia Avenue
° s ��� ® Ft Fierce, FL 34982
BY Phone: 772- 462-2165
ILli de Countv Fax, 772-462-2522
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Request for 30--Day Temporary Power Release
Perwit Number.- -`
Aad,s- i o�ol S Cc r` fir. Jtrs„rz �r�c_.hi.�t. ?�4s-1 •„-,._
UNDERSIGNED HE' REBY REQUEST RELEASE OF ELECMCAL POWER TO ME
VE DESCRIBED PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30) BAYS, FOR
PURPOSE OF TESTING SYSTEMS AND EQUIPMENT IN PREPARATION FOR FINAL
EC'TJiON, IN CONSIDERATION OF APPROVAL OF TBE REQUEST WE HEREBY
NOWLEDGE AND AGREE AS FOLLOWS:
I. This temporary power release is requested for the above stated purpose only, and there will be no occupancy
of any type, other than that permitted by construction during tbis time period,
2. As witness by our signatures, my hereby agree to abide by all terms and conditions of this agreetneat, including
. Building Divisio>« policy, which is incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled." itcquiremeuts for 30 fray Power for
4. Testing" have been Mulled and the prenlise is ready 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 Stun Work Order issued if the .l' ual .Inspection
has not been approved. within 30 days. A, fee of $190.00 will be !required to Lift the Stop Work Order.
HEREBYRELEA,SE AND AGREE TO HOLD HARMLESS, ST, LUOE COUNTY, AND
JR EMPLOYEES PROM ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE
1CH MAY ARISE NOW OR IN THE FUTURE OUT OF THIS TRANSACTION, INCLUDING
" DAMAGE WHICH MAY BE INCURRED DUE TO THE DISCONNECTION OF
C'TRICAL POWER IN THF, EVENT OF VIOLATION OF THIS AGREZMENT.
TURE
C'
SIGNATURE
�� 4+ XPDSD ReAfed 06K14120.10
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