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NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Plr3CP t1NR et TM1Yit1t
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Date 11014
Property Address 4-SS4- IV. QECk
Name of Property Owner 1 3 4 4h iuLrMf
I. o children less than six years of age reside at this address.
II. 0 A child under the age of six years of age resides .at this address.
(If tkie3,.ta: :, L ;.?. ,;;1. trxeivad. .FoA..,.., aar...
protection.)
A. 0 We will provide an interior fence and enclosure
around the pool as required by Glendale Pool
Barrier Ordinance.
B. 0 We will provide exterior fence and enclosure
nrotectinn with cercnnrdary nrotection as checked on
reverse side of this affidavit per the Glendale Pool
Barrier Ordinance.
(COMPLETE REVERSE SIDE)
Page 1 of 2
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all Community
GLEND E
i flo'raias mart ( rru t
v i v v 111 V ii V V 1 ..........V
1. n The poal sh,2it be rwr rented by 2 ...l.tv.-.e 7 f pool covcr.
2. 0 Doors and windows protected.
3. 0 The pool shall be protected by an alarm maintained in or on
the swimming pool.
4. tJ The above ground swimming pool shall have ladder secured.
5. 0 Locking hard safety cover on the spa or hot tub.
•
6. 0 Alternative protection not specified above which is attached
14 to the plan submittal and submitted for approval by the
11" �.
building official.
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Pool Contractor(Print) ctor !gnat c Date
frSIGNATURE OF OWNER MUST BE NOTARIZED Ciis --
State of Arizona
County of Maricopa
On this day of ,20 A before me personally appeared
C __ signer).whose identi t,., .o. .a to n:e on
th asis of satisfactory evidence to b the person whose name is subscribed to in this document,
and who acknowledged that he/she signed thU-A-k...-0\4-,"
eabove/attached document.
sea l �����J `(3
o "' ' HEATHER J. HESS
Notary Public
Notary Public Arizona
Maricopa County ► ?r.-�,If?
iq • My Comm. Expires Jan 31,2015
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