CITRUS COUNTY BUILDING DIVISION
Application For Temporary Electric Service
| Date: ____________________ |
Building Permit #: ____________________ |
In accordance with the provisions of section 14, of Citrus County Ordinance 98-A09, we hereby apply for temporary power for the above building permit for10 days, commencing on connection of service by the power company. We will notify the Building Department on date of connection and will request the power company for a disconnect at the end of 10 day period. We agree to comply with all provisions of County Building Ordinance and the National Electric Code, adopted by Citrus County.
We, the builder and electrical contractor, assume all responsibility and liability from any damages resulting from this temporary service and relieve Citrus County and their lawful agents from any responsibility or liability as a result of this temporary service.
| Builder Signature: __________________________ | Electrician Signature: __________________________ |
| State of____________ County of ___________________ |
State of____________ County of ___________________ |
| The foregoing instrument was acknowledged before me this ________ of ____________________, _______ by ________________________who is personally known to me or who produced ___________________ as identification and who did or did not take an oath. | The foregoing instrument was acknowledged before me this ________ of ____________________, _______ by ________________________who is personally known to me or who produced ___________________ as identification and who did or did not take an oath. |
| _______________________________ Signature of Notary |
_______________________________ Signature of Notary |
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