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PERMIT# ISSUE DATE
PLANNING &DEVELOPMENT SERVICES
Building & Code Compliance Division
r
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
4
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5
have agreed to be
(Company N me/In lvidual Name)the ��`' f i C A ti Sub-contractor for S Pool
(Type of Trade) (Primary ontractor)
For the project located at / 75 LO r
(Project Street Address or Property Tax ID#)
It is understood that, if there is any change of st*s regarding our participation with the above mentioned
project,the Building and Code Regulation Divpibn of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
1
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CONTRALTO GNATURLK((rufiWen6SUB- ONT CTOR S NATURE(Qual'
PRINT NA PRINT NAME
c 93,:;), �
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of State of Florida,County of IF
The foregoing instrument was signed before me this day ofi I The foregoing instrument wassigned be/fore me this day of
1j— ,ZOl7 by � ,20 /,by
who is personally known_L___`011 has produced a who is personally known 1-r has produced a
as identification. as identification.
STAMP STAMP
Signat e o otary Public Signature of Notary ublic
Print Name of Notary Public Print Name of Notary Public
►� Pao C 0 MILLS C 0 MILLS
Commission#FF 228285 Commission#FF 228285
My Commission Expires MY Commission Expires
Se r 4 201 bar 4 201
5
Revised 11/16/2016
PERMIT# ISSUE DATE
PLANNING & DEVELOPMENT SERVICES
Building & Code Compliance Division
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
RECEI�'7_D JUN 2 e 2017
have agreed to be
(Comi4any Name/Individual Name)
the P I y r Sub-contractor for 01 L4,5po/S
(Type of Trade) (Prim Contractor)
r For the project located at 51 7 �Yi4�Pe,,J j r� l�-►
� f V
(Project Street Address or Property Tax ID#)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St. Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
CONTRXCTOR SIGNATURE(Qualifier) SUB-CONTRACTOR SIGNATURE(Qualifier)
6 7
PRIN NAME PRINT NAME
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER
State of Florida,County of�r/L State of Florida,County of
The foregoing instrument was signed before me this o? day of The foregoing instrument was signed before me this day of
e 29/; ,by c '� C ,20_,by
who is personally known or has produced a who is personally known or has produced a
as identification. as identification.
/X&cx STAMP STAMP
Signatu of Notary Public Signature of Notary Public
Print Name of Notary Public r n B Commissio 228285 Print Name of Notary Public
n#FF
My Commission Facpires
Se temper 4 2019
Revised 11/16/2016
PLANNING AEVELOPMENT SERVICES DEPAMENT
Building and Code Regulations Division
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
AFFIDAVIT OF REQUIREMENT COMPLIANCE REC
Swimming Pools S and Hot Tub Safe Act E� "�
Residential Sw1
g P�, � -D ION ti 6 20,7
PERMIT#
I(We)acknowledge that)a new swimming pool,spa,or hot tub will be constructed or installed at
�17 Sr SD1'9 1W 1-)4 17A4 i 1 and hereby affirm that one of the following methods
(Please print street address)
will be used to meet the requirements of Chapter 515,Florida Statutes: (Please initial the method used for pool.)
The pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statute 515.29.
The pool will be equipped with an approved safety pool cover that complies with ASTM F1246-91(Standard Performance Specifications for
Safety Covers for Swimming Pools,Spas,and Hot Tubs).
All doors and windows providing direct access from the home to the pool will be equipped with an exit alarm that has a minimum sound
pressure rating of 85decibels at 10 feet.
All doors providing direct access from the home to the pool will be equipped with self closing,self latching devices with release mechanisms
placed no lower than 54 inches above the floor or deck.
I understand that not having one of the above installed at the time of final inspection,or when the pool is completed for contract
purposes,will constitute a violation of Chapter 515,F.S.,and will be considered as committing a misdemeanor of the second degree,
punishable by fines up to$500.00 and/or up to 60 days in jail as established in chapter 775,F.S.
I understand that the St.Lucie County Building Inspections Department assumes no liability for the final inspection of one of the
above protective devices,or the lack of maintenance,or the removal of such after the swimming pool has been finalized.
I,the contractor,agree to instruct the owner of the proper use and maintenance of such safety device.
CONTRACTO IGNATURE OWNER SIGNATURE r�
STATE OF FLO A,COUNT F L STATE OF nOWDA,COUNTY F
X/ , , 11Xg
NOTAR PUBLIC NOTARY PUBLIC
The foregoing instrument was acknowledged before me The foregoing instrument was acknowledged before me
this tw
day of / Uh ,20,Z 7 , this day of o/ �Jn P 12012
by �q r /1 by f-r�
Personally Known or Produced identification Personally Known r/ or Produced Identification
Type of Identification Produced: Type of Identification produced:
aY Po
Commission nFF 2282�6 �; Commiss one#FF 228M
My Commission toxpIm - INy Commission Expires
Se tember 4 2019 September 4 2019
SLCPDS Revised 07/22/2014