HomeMy WebLinkAboutAPPLICATION FOR PERMIT REVISIONSi
OFFIClE USE ONLY: ` `
DATE LI ILED: S 1 � 1 `A
REVISION FEE: �' 3
By
vERMIT #
RECEIPT #
PLANNING & DEVELOPMENT SERVICES
BUILDING & CODE REGULATION DMSION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982.5652 c®l?y
(772) 462.1553
APPLICATION FOR BUILDING PERMIT REVISIONS
PROJECT INFORMATION
LOCATION/SITE
ADDRESS:
� J '
DETAILED DESCRIPTION OF PROJECT
REVISIONS: .:_...
es —
CONTRACTOR INFORMATION:
STATE of FL REG./Tnn#: ST. LUCIE CO CERT. #:
BUSINESS NAME: 1JIL
QUALIFIERS NAME: C VX w 1 Y) y-1
ADDRF$S: Cam. U� LW
CITY: t 111� J STATE:
PHONE (DAYTIME):
!�21-
OWNER/BUILDER INFORMATION:
NAME:
ADDRESS:
ZIP:
FAX:
CITY: STATE:
PHONE (DAYTIME: FAX:
ARCHITECT/ENGINEER INFORMATION:
NAME:
ZIP:
ADDRESS:
CITY: STATE: ZIP:
PHONE (DAYTIME): FAX:
SLCCC: 9123109 Apa%L 10 OL M
Revised 06130/17 Ht:vIzi
Planning & Development Services
•,
....� � � Building & Code Regulation' Division
2300 Virginia Ave
Fort !Pierce, FL 34982
772-462-2165 Fax 772-462-6443
Request for 30-Day Temporary Power Release
Dike: �� �� _ Permit Number: Jc� S
Project Address:
RECEIVED
NOV 15 7019
Permitting Department
St. Lucie County
SCANNED
BY
St. Lucie Cmuviv
THE UNDERSIGNED HEREBY REQUEST RELEASE 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:
1. 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 this time period.
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 andlor a Stop Work Order Issued if
the Final Inspection has not been approved within 30 days. A fee of $I00.00 will be required to lift
the Stop Work 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 FUT'LIRE OUT
OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE
DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT.
LURE
BATE��
DATE
CONTRACTOR SIGNATURE DATE ��'�