Environmental Protection and Growth Management Department
BUILDING CODE SERVICES DIVISION
1 North University Drive, Box #302 • Plantation, Florida 33324 • 954-765-4400 • broward.org/building
30-Day Temporary Electric Permit Application
THE FOLLOWING STATEMENT IS TO BE EXECUTED BY THE ELECTRICAL CONTRACTOR OF
RECORD FOR THE PREMISES ON WHICH TEMPORARY 30-DAY ELECTRIC SERVICE IS REQUESTED.
THIS IS IN COMPLIANCE WITH THE FLORIDA BUILDING CODE 111.2.
It is understood that the temporary 30-day electrical permit approval given by this Division is being approved only
for the testing
of the following installations:
BUILDING PERMIT NO.: ELECTRICAL PERMIT NO.:
Job Address: Unit: City:
Electrical Contractor: Phone No.:
Such approval is not to be considered a release of said structure for purposes of use and/or occupancy.
FLORIDA POWER AND LIGHT COMPANY WILL BE NOTIFIED THAT YOUR TEMPORARY POWER WILL
BE TERMINATED ON:
This document must be notarized to be valid.
Master Electrician’s Signature & License No.
OR
Property Owner’s/Authorized Agent’s Signature
Building Chief’s or Chief Electrical’s Signature
STATE OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
___ day of ____________________, 20___, by
(Type / Print Property Owner or Agent Name)
NOTARY’S SIGNATURE as to Owner or Agent’s Signature
Notary’s Name (Print/Type or Stamp Notary’s Name)
Personally Known ______ or Produced Identification _______
Type of Identification Produced
Revised 2/17
