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PLANNING & DEVELOPMENT SER8710ES DEPARTME,N
Building and Code Regulations Division
2300 4,JRGIN I A AVE
FORT PIERCE. FL 34991
(772)462-1553 Fox(172)462-1518
AFFIDAVIT OF REQUIREMENT COMPLIANCE
Residential Switurning Pools, Spa, and Hot Tub Safety Act
PERMIT 4
1(We) acknowledge that a new s*jmming pool, spa, or hot tub will be constructed or installed at methods
8612 COBBLEsTONFR DR. FT PIERCE FL and hereby affirm thiil(one Of the following
I
I please print strest address) tes: (please initial the method used for pool.)
will be used to meet the requirements of Chapter 515, Florida Siatu
• The pool 1-111 N s-4-tIll rn,m acco to lb.h.nit by an encimure that rilecl� The Pool barrier mcluffemenis ofFlorida Si.taw 51519.
The pool will be Ntlii)Ped with an Al"PrOvej sait, pool covlt that complies with ASTM F1246-41(Standard Parforomncc for
5and Hot TuWi.;Afct� covl:Th for swinmilar Pool.%. Spas, a
Ali doors and windows pi—J111119 direct access from the hone to the pool will he equipped with an exit alann tW1 lhit a rolrerrunt Nm;)%i
Dressur", rating ofX5dw'hqls at Ill feet.
tE1N 0 W ill $61 r1rig self lAtching de wifil rtleasc med'anisril,
All 4100i's PrOV111144 thre-f "aces' rr'"' the I")'" to the pits , 'C I — 1ARW
placed no tower iwo 541nches above 'he floor or dccl, f-&L -A H - 34A
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 tOS,.qJ)0.G8 and/or up to 60 days in jail as established in chapter 775, F.S.
I understand that the St. Lucie Counts Building inspections Department assumes no liability for the final Inspection of one of the
above protective devices, or the lack of maintemuiceor the removal of such after the swimming Pool has been flualimd.
l,thecoutra or, agree to instruct of the proper use and maintenance liff'suctl satetv device'
ow.1,,ER SIGNATURE
1.'0 'If' the
S�IGNAT 'RE
N'TV or
OF FLORIDA. COVINIn' OF 4 ____Llj A' sTA>rZI)FLORII)AXOV
LIN
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4-4-4A-440 .. . OTAItY PUBLIC
N �ARY PUBLIC
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The foregoing instrument was acknowledged befork, me The foregoing instrument was acknowledged before the
his )!—� 0 bi., of
qdAy Of _Jq DL
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Personally Known or Produced identification Personally Kmawo or Produced Identifirallon—
e of identification produced: Ry Josandra A. Ingraham
Type Type of identification Produced: N TARY PUBLIC
—STATE OF FLORIDA
yq Josandra A. Ingraham Comni# GG954178
NOTARY PUBLIC�HCE Expires 3/9/2024
—STATE OF FLORIDA
Comm# GG954178
Expires 319/2024