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COrmaraiiity
Development Group
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NEW SWIMMING POOL
- PLAN SUBMITTAL AFFIDAVIT •
Ordinance.#2046
Please type or print
Date "' 24 _I 3
Propert Address 8/0e• W 1-N iA KIE AJ€) ,efr Q_,
Name of Property Owner D I Jo /
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T. g No .children less than six years of age reside at this house.
IL ❑ A child under the age of six years of age resides at this house.
(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.
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B. 0 •We will provide exterior fence and enclosure protection
with secondary protection.as checked on page two of
this'affidavit per the Glendale Pool Barrier Ordinance.
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(COMPLETE OTHER SIDE)• -
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1 0 The pool shall be protected by a motorized safety pool cover: _•
2,. El 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 ladder secured.:
• 5. ❑ Locking hard safety cover 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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41). e"--2c--26 13 •
Name of Home Owner(Frint) Home 0 : Signature Date -
SIGNATURE OF OWNER MU T BE NOTARIZED -
(a/, i;g /c> 1//°/ /
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Pool Contractor(Print) / . Co, I acto :igna - Date
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t i- )" , COUNT,
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