HomeMy WebLinkAbout30 DAY TEMPORARY POWER RELEASEJan 3 2014 11:0719M MP LR!' � 7E7
i= ri x
Page 2
SCANNED
By
,ell Lucie CONIA1
P1slnuiug & D&VVIapruent Services Department
Building & Code Regulations Division
231tf1 Virginia Avenue
FF Pik,rce, dPL 34902
li4W 772-iGa-xt0
Paz.17a.4=92
Request for 30-D�y Temp�orsty Poweir Reiggae
Dyt~t�JJ_, 11 Ptrtuft Nt�9Mbdk':.� 1—. ... �..i..L.ri�
SS
eject Addrm: I MA %/I lV 4W A raw,► nO
''rSE UNDERSIGNED =RKUY REQUEST i X1XASZ OF EL1ECUUCAI,POWFAt TO THE
ABOVE nZ8CR1M1b PRp1a'E R`I 1`'', VOR A P.E100D NOT'ro EXCEED TIMITY (30) DAYS, frOf t
THE PLIMSE OF TESTING SYSTEMS AND EQi'Li11)M91gT IN P90ARATION POR M. L
INSPECTION. IN CONSWERATION OF APPROVAL 019 THU REQUEST WE HEREBY
ACICNOWIADG9 AND AGAZE AS FOL1:.OWS.-
1. 7 hls WhPunry power ralno#w is rcvivsead for tho gouve stated pu peac auly, and alum wid ba Ilia ancup;Mpy
urany typo, otamr tlttix ('13yt pervAittcd by c0askrrUtiatl durtdg thls'lh)jt poria&
Z. Au witatse by our sletltirlUi%& we hereby ngyeew abide by nil tsrmu and conditioes (it this ahreiunvar, Including
13uu tng Dmsion Policy, which to incorParuted herein by roftr"cw
' .. All otmWitlaoe and rertul8eumentm Jiltud Yu thr attUchotl doeumsnt eUtttlad `°1Rorjt�k4= 2tY for 30 flan M4urYer Yor
a. Usl ng" have neon 1rdliUad sud the prerul" is rurdy &f cawaplWaca inspectiotY,
S. All rt409sts fah nn u%eopdWlan hdywdq,e days muxt be 4adr in wi "g to tldu tiuildhtt yillicittlstaGt tuo rarwoa
t'or thu tevm t Power raby be removed fiVig tho situ and/or a Star Work OrcW issued It tho f+icual inupoetion
has dtot boon apprarod withlq 30 dayt. A tea of Jltiii o0 will be required to lilt file Stop'Wm.1k Carder.
VE f=E$Y MRA6E AMD AGREE TO HOLD ffAANMrbSlS, ST- LUCft COUNTY, AND
'BEM V'MF yEES IrX#<)M ,AM ZAABYL.D"iIES AND CLAIMS OF ANY TYPE OF NATUJW
YW'CR I'1'YA►Y A,91SE 1VOW OR IN l''D`M FUTURE OUT OF TM6 kANSAC ION, INCLOHNG
+ANY DAMAGE IC'K MA'tt' BE INCUMM D DUE TO THE DISCONNECTION 41?
ELEC"UCAY,, POWER IN MW EXENT OF VIOLATION OF TIM AOREgiV NT.
st.Cpusu rdevi" agog Colo
�a� eriri�a�lrtoa awr
RECEIVER ►^"� ��$ �.14
Z966SOZZLL 00:ez 0194 Z.Z/Z$
39dd JNIlOV�UNOO OWL'
t860£8zztt LZ:£Z bTOZ/ZZ/T0