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2. Permit Number
3. Address
5. Notice of Requirements

   I (We) acknowledge that a new swimming pool, spa or hot tub will be constructed or installed at the above-referenced address, and hereby affirm that one of the following methods will be used to meet the requirements of Chapter 515, Florida Statutes.

7. Please mark the method(s) to be used for your pool

   1. The pool will be isolated from access to the home by an enclosure that meets the pool barrier requirements of Florida Statue 515.29.
   2. The pool will be equipped with an approved safety pool cover that complies with ASTM F1346-91 (Standard Performance Specifications For Safety Covers for Swimming Pools, Spas, and Hot Tubs).
   3. 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 85 decibels at 10 feet.
   4. 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 inces above the floor or deck.
9. Acknowledgement

   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 and/or 60 days in jail as established in Chapter 775 F.S.

11. Contractor's Signature
12. Date
    Date
14. E-mail Address
16. Owner's Signature
17. Date
    Date
19. E-mail Address
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21. 1. Receive an email copy of this form.
22. Email address

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23. Submit

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