City of Clermont
Building Services Department
Request for Main Power Prior to Certificate of Occupancy
Date:___________
Permit #____________
Project:__________________________________________________________________
Owner:__________________________________________________________________
Contractor:________________________________________________________________
We request this project be electrically energized for _______ days for the following reasons:
We understand and agree that this facility is not to be used or occupied prior to a Certificate of Occupancy being
issued, and if you should hereafter find that the facility has been occupied before a Certificate of Occupancy has
been issued, you have the unilateral right to direct that the electricity be disconnected without notice.
Furthermore, we understand and agree that should you exercise such right, the City of Clermont will not be
responsible for any damages or costs which may result to either or both of us from the exercise of such right. Also,
in the event any third party claims that they have been damaged by the exercise of such right, we agree to jointly
or individually indemnify and hold harmless the City of Clermont for all such damages and costs, including
reasonable attorney’s fees.
THIS REQUEST IS NOT APPROVED UNLESS SIGNED BY THE CITY OF CLERMONT BUILDING OFFICIAL
($100.00 DUE UPON APPROVAL)
_____________________
____________________
Signature of Owner Signature of Contractor
Sworn to and subscribed before me,
by means of
☐
physical presence
or
☐
online notarization, this _____day of
________, _______(year), by __________
and who is personally
known to me or who
has produced ________________ as
identification.
Sworn to and subscribed before me,
by means of
☐
physical presence
or
☐
online notarization, this _____day of
________, _______(year), by __________
and who is personally
known to me or who
has produced ________________ as
identification.
__________________________ ___________________________
Notary Public Notary Public
