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GLENDfE
NEW SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date 2-11-2020
Property Address 17840 N. 74th Dr., Glendale AZ 85308
Name of Property Owner Gary and Kelly McCoy
I. ❑ No children less than six years of age reside at this address.
II. El 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. V 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.
(Complete Reverse Side)
City of Glendale
Development Services• 5850 West Glendale Avenue•Glendale,Arizona 85301-2599•Phone(623)930-2800
www.glendaleaz.com
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GLEMDSLE
O 1 . The pool shall be protected by a motorized safety pool cover.
O 2. Doors and windows protected.
O 3. The pool shall be protected by an alarm maintained in or on the
swimming pool.
O 4. The above ground swimming pool shall have a ladder secured.
O 5. Locking hard safety cover on the spa or hot tub.
O 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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Name of Ho t ��
me Owner(Print) Homewner Signature
oate
Dane Pearson ._ 2-11-2020
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa _
On this y of , 20 Zb, before me personally
appeared C b (name of signer), whose
identity was p ovei me on th basis of satisfactory evidence to be the person
whose name is subscribed to in this document, and who acknowledged that
...he./she sigiped ablve/ ttached document. i�`
����c�ir�rt KARUN ROSE MCKIBBEN lis„ / commsno56o229ll9,
a( ="" \� Notary public Arizona
1 �� 'S• Maricopa County .sio My Comm.Expires Jul 23,2023
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(Seal) 1 10 Nota , Public
City of Glendale
Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599• Phone(623)930-2800
www.glendaleaz.com