HomeMy WebLinkAboutFilled Land Affidavit-- PLANNING & DEVELOPMENT SERVICES DEPARTMENT
o Building & Code Regulations Divisi
2300 VIRGINIA AVENUE RECEIVED
FORT PIERCE, FL 34982-5652
(772) 462-1553
Nov 0 3 2017
FILLED LAND AFFIDAVIT Department
Permitting
St. Lucie county,
I, the undersigned, am the owner of the following described property,
3S2_?-5QI--6.-ocv-
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
Property Owner ame (Please Print)
I1I r
Property Owner Signature
/0 2-O 1 %
Date
STATE OF FLORIDA, COUNTY OF P(JI I i' 1 �� 1
ACKNOWLEDGED BEFORE ME THIS �N_ODAY OF _y(�" I ut� 20�
ev.
Y==
SI NATURE OF TARY PUBLIC
�2_COMMISSION NUMBER
WHO IS PERSONALLY KNOWN TO MELER
OR WHO HAS
AS IDENTIFICATION.
. m6ao ro'�W_r
TYPE OR PRIWNOTARY
(SEAL)
Y
SLCPDSD Revised 04/11/2011 }' M1IRGOP05NER
MY COMMISSION FF 176769
:4= EXPIRES: November 12, 2018
�'A(f BondedTlwNolaiYPubr�cUndervmters
PLANNING & DEVELOPMENT
Building and Code Regulations
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
(772)462-1553 Fax (772)462-1578
AFFIDAVIT OF REQUIREMENT C
Residential Swimming Pools, Spa, and H
PERMIT #
. i
;MVE
NOV 0 3 2017
ing Department
ty�& C-ounty, FL
I (We) acknowledge that a new swimming pool, spa, or hot tub will be constructed or installed at
7912 S. Ocean Drive, Jensen Bach, FL 34957 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.
c
CONTRA6TOR SI NATURE OWNER SIGNATURE
STATY'/OF �LORIDA, COUNTY OF Sf (,(%CLly
NOT
The foregoing instrument was acknowledged before me
this K? day of 5LL� , 204—
by
Personally Known or Produced Identification
Type of Identification Produced:
JAMES ROUAN
W COMMISSION # W 008627
SLCPDS Revise ffe EXPIRES: November 4, 2020
Bont?na?hna Notary r"vbk underwriters
STATE O FLORIDA, COUNTY OF grvw0.f A
NOTARY PUBLIC
The foregoing instrument was acknowledged before me
this 164'�' day of -J4 nt , 20 1'1
by rnw Erse e-
Personally Known or Produced Identification
Type of Identification produced: i:1orlda Dryers Ueens2-
Heatller Lewis
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF949603
Expires 1/11/2020