Pre-Power Request Form
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1PRE-POWER REQUEST
06/03
TO:
Growth & Resource Management
Date__________________________________________
Permit Center
123 W. Indiana Ave., Room 203
DeLand, Florida 32720-4253
Permit No._____________________________________
**ALL FEES MUST BE PAID RELATED TO THIS BUILDING PERMIT**
Building Identification ____________________________________________________________________________________________
Address _______________________________________________________________________________________________________
The undersigned hereby requests permission to connect the electric current to the above named building for a maximum period
of______________ days prior to the final inspections.
Name of Power Co. ________________________________
Start Date: __________________
Cut off Date: __________________
The reason for this request is as follows:______________________________________________________________________________
______________________________________________________________________________________________________________
The undersigned also certifies that the wiring, apparatus and fixtures of the entire building are in such condition that electrical current may
safely be connected therewith for such period of time and there exists a necessity for this request. The undersigned also understands and
agrees that approval of this request does not constitute a waiver of procuring a Certificate of Occupancy prior to any type of occupancy of
this building. Should the building be found occupied without a Certificate of Occupancy having been issued, The Volusia County
Building Official has the right to have the power disconnected.
Contractor
____________________________________________
______________________________________
Contractor’s Signature
License Number
STATE OF FLORIDA
COUNTY OF _________________________
Affirmed and subscribed before me this ______ day of __________________ 20_____ by ____________________________________
.
who is personally known to me or who has produced __________________________________________ (type of ID) as identification
________________________________________
________________________________________
Signature of Notary Public, State of Florida
Print, Type or Stamp Name of Notary
Notarial Seal
**************************************************************************************************************
Owner (Fee Simple Titleholder)/Leaseholder (If leaseholder; a lease showing at least 29 years must be attached)
______________________________________________
Owner’s Signature
STATE OF FLORIDA
COUNTY OF ______________________________
Affirmed and subscribed before me this ______ day of ____________________ 20 _____ by ___________________________________
who is personally known to me or who has produced ____________________________________________ (type of ID) as identification.
________________________________________
________________________________________
Signature of Notary Public, State of Florida
Print, Type or Stamp Name of Notary
Notarial Seal
**************************************************************************************************************
Electrician
____________________________________________
______________________________________
Electrician’s Signature
License Number
STATE OF FLORIDA
COUNTY OF _____________________________
Affirmed and subscribed before me this ______ day of __________________ 20_____ by ______________________________________
who is personally known to me or who has produced ____________________________________________ (type of ID) as identification.
________________________________________
________________________________________
Signature of Notary Public, State of Florida
Print, Type or Stamp Name of Notary
Notarial Seal
***************************************************************************************************************************
RESIDENTIAL NEEDS APPROVAL OF BUILDING OFFICIAL
Inspector
Inspection completed by _________________________ Date _______________ Power Company called: _________________________
by ___________________________________ Date _____________________ Talked to ______________________________________
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