HomeMy WebLinkAbout84014 10 ku\
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City oGlendale
Gi- E Development Service Center
NEW SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date ' /21/it/-
Property Address
Name of Property Owner kilit v, ,(bkl lY(A.Ry Ai Af
I. {K No children less than six g
years of age reside at this address.
II. U 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. U 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.
GUAM ID . C`p,INk
MC A!.ae0 sinicne3 ix:weir-F* W v ,.
(Complete Reverse Side)
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4PP
O Cit \of Glendale
Mi
GI-EDevetOpment Service Center
II 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 alai inn maintained in or on the
swimming pool.,
❑ 4. The above ground swimming pool shall have a 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.
' ,(Nr-.,.\ \\• \.\�eJA 1-2/5- ( q
ame of Home Owner(Print) Home Owner Signature Date
AT G4l/ --( 7 bt I'd"` 7/2-9 b(f
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this a day of , 2014 , before me personally
appeared IDDfl , ( a Ll (name of signer), whose
identity was proved to me on the basis df 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.
BARBARA JEAN DURBIN
I
•
(160,a(auct
1A-A- 6i-dillu
(Seal) Natal ublic
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