HomeMy WebLinkAbout76806 (2) . . ----7 6
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NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date 1/-a 3 -/3
1 Property Address e/O?-6. Ai 7 /A /2v E_/
Name of Property Owner 0e 1 e D IJ
I. ❑ No children less than six years of age reside at this address.
II. X A child under the age of six years of age resides at this address.
identify method of secondarypool protection
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this box is checked, de fy p p )
A. Ve will provide an interior fence and enclosure around the pool Rs
equired by the Glendale Pool Barrier Ordinance. I
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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1
fii Community
GLENL,ItE
Development Group
1. ❑ The pool shall be protected by a motorized safety pool cover.
2. ❑ Doors and windows protected.
3. El The pool shall be protected by an alarm maintained in or on
the swimming pool.
4. D The above ground swimming pool shall have ladder secured.
5. D 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.
a li L-/ 44- jb t i )/t/ `7)1 , d�a� `17re43
Name of Home Owner(Print) Home Ow rs Signature Date
i
1-2 / Za',r,a ice;t ,e/2 i /3
Po l Contractor(Print) tractor Si ature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
941 this o?? day of // , 20, before me personally appeared
f /1?_-Lee, (name of signer), whose identity was proved to me on
the basis cif satisfactory evidence to be the person whose name is subscribed to in this document,
and who acknowledged that he/she signed the above/attached docu nt
(se 14.- EL4NA LONG
A. � l ^ ►Y Arizona otary Public
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FwallarY 9 2014 Page 2 of 2