HomeMy WebLinkAbout144051 ARIZONA.? „.a77,
SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
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Date // /2 I P OS I
Property Address 4`JJ jv f6J4 Li `e gz Ks:i ,z,
Name of Property Owner --ii y45 C/c/I
1. ✓ No children less than six years of age reside at this address.
IL ❑ A child under the age of six years of age resides at this address.
(If this box is checked, identify method of secondary pool protection.)
A. ❑ We will provide an interior fence and enclosure around the pool as
required by the Glendale Pool Barrier Ordinance.
B. ❑ We will provide exterior fence and enclosure protection with
secondary protection-as checked on reverse side of this affidavit per
the Glendale Pool Barrier Ordinance.
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City of Glendale
Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599
Phone(623)930-2800•www.glendaleaz.com
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❑ 1. The pool shall be protected=by°a motorized safety pool cover.
❑ 2. Doors and windows protected.
;.
❑ 3. The pool shall be protected by an alarm maintained in or on the
swimming pool.
❑ 4. The above ground swimming pool shall have a ladder secured.
❑ 5. Locking hard safety covet on the spa or hot tub.
❑ 6. Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the building official.
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of - e-Owner-(Print)- .. - me-G-Wner-Signaturc Date
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this .2 day of\\ ` YV-3-2 r , 262, before me personally
appeared (\nc,tf,, (name of signer), whose
identity was proved to me on the basis of satisfactory evidence to be the person
whose name is subscribed to in-this document, and who 'acknowledged that
he/she signed the above/attached document.
P., KLARIU C OCHOA '
a Notary Pubik-Arizona
Maricopa County
Commission M 613642
My Comm.Expires Oct 2,2025
(Seal) ary u lic
City of Glendale
Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599
Phone(623)930-2800•www.glendaleaz.com