HomeMy WebLinkAbout140670 City of Glendale
01
Gj Development Service Center
SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date .) 111 '2b 14
Property Address 5 6' L), rnE elEtAlaT ir\2. as 313C
Name of Property Owner A LL E ) Fi )
I. X No 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 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. 0 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)
Page 1 of 2
(.;
•
•
- ..
j Y s •
•
•
•
_
t •
•�i • R y
•
.a. .✓. ._� •- @ .
y
•
rC a
'e e
•
i ?t" � a �.' 4 ,zv�i _ J . .:l J� !' I� '.J -.)04 .iT i>'{ l .n..iy
1�`. i ' s ' s b" :jt .,t�i.�7.r,. ;•t r-;
• t
•
•.. J 1:,.7 ;. '~y cs ► err ; ' �
r ri City of Glendale
GI Development Service Center
❑ 1. The pool shall be protected by a motorized safety pool cover.
❑ 2. Doors and windows protected.
O 3. The pool shall be protected by an alarm 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.
O 6. Alternative protection not specified above which is attached to the
plan submittal and submitted for royal by the building official.
Li-EP FPtg 1-111-,INY
Name of Home Owner(Print) ome Owner Signature Date
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this 14 day of 20/ , before me personally
appeare (name of signer), whose
identity as proved he basis of satisfactory evidence to be the person
whose name is subscribed to in this document, and who aclaaowledged that
he/she si ed the above/ cument.
„.0 slit„ KAREN G.MARMOL
NOTARY PUBLIC-ARIZONA
;,, ►^�=� �" Maricopa County
My C J �
ne i18,20E7rea
dts�b
(Seal) No ub is
Page 2 of 2