HomeMy WebLinkAboutPool safety affPLIN's UG & DEVELOPMENT SERVICES DEPARTMENT
r Building and Code Regulations Dhision
2oW \IRGI%IA AI'E
FORT PIERCE:. ill Most
ITIIMi-159 in1^iL K2-IS^a
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Swimming Pools, Spa, and Hot Tub Safety Act
PFRsuT Is
I (w'c) acknowledge that anew swimming pool. spa. or hot tub will be constructed or Installed at
9612 COBBLESTORER DR. FT PIERCE FL and hereby a@Irm that one of the following methods
IPkae prWl rvM rddrorl
will he used to meet the requirements of Chapter 515, Florida Statutes: (Please midal the method used for peol.l
F( Thetan(.JI re nAnol from a1;1'I"den h•aneh'an cminwmllm mcm:ncp.w•IIwnR requnamem. nl FlrviJl i:amm 515=�
Thcpnrl%ill N,,IapPN xlNaneppo•eeJufns Foal m.n Jsn <mlyhb xiN SIM1`1241, a1�4anJard Ya(wmercv S(cnri:.nianaa
Salm l'm n. La Pad.. SPas am1 it. 'falni
_ _ 111 J•ue.+nJ umdnx.pm•uLnp dn<n avca»h•snlhe rumens she p'°I ntllh:gmps8 x,Ih nil clean llul lu+a minimum+rnJ
to nwrc...IV at s5Jcnha', o w Ile,
nil dn.x>'r .IkprJnx axa. In•m 11-1
pb¢J oy.d• q..cifon, Jc3"I,.mechamrva
nu Wwv own A lnclaa@n-ARM 1 underslund that nth hniag one of the abuse installed at the time of Ooaall inspection. ur when the pool b completed for contract
purposes, will coostb ule a Nobtlon of Chapter 515. F.S., and trill be canddrred as committing a misdemeanor of the second degree,
pom,habic b, Beres up m S500.00 m i(or up to 60 days in jail as established in chapter 775. F S.
I understand that the St. Lucle Count, Building Impeedma Department assume, no liability for the final inspection of one of the
above prmeedvc desices, or the lank of mamenance, or the remosal of Inch after the swimming pool has her- RnaOeed.
I. the om, rojsor. agree to instruct t awnet of the proper nw and maintenatnet
/of such safety desire.
I ONNEACTORS1044TI'RE ONYER SIGNATI RE r
S1Aft OFMOmDA.Cov%S ,oF
74141 PUBLIC 0
The foregoing instrument IwIo arknonledgad before nth
this _ qda, m�4_�. 2a�Q.
It, Wad e ^1
a' Personally xnown or ProdocW mortification
Type of Identification Produced:
0,KRJo5ondra A. Ingraham
NOTARY PUBLIC
STATE OF FLORIDA
slernsCann# GG954178
Expires 3/9/2024
`STA - iLOBIDA.COCVTI'OP wlA '�^
lW
ir T ART Pt BLIC
'i he foregoing no rUem,nt was.0lansniedged before not
this —!+da, nr_k J�/ sp ZtD
Personally Known or Produced identification_
Type of mesuirtion Produced: Josandra A. Ingraham
ARY PUBLIC
STATE OF FLORIDA
Comoro GG954178
T Expires 3/9/2024