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GLENDfE Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046 .
Please type or print
Date <.5P/JO t 4
Property Address b 3-7p W M id W Gl 74w 1 Tei,AvAL/A_z_ OS 3
Name of Property Owner 4,t'(1& K f tA-1il t/
I. CINo children less than six years of age reside at this address.
II. A child under the age of six years of age resides at this address.
(If this box is_checked, identify method of secondary peel-protection)
A. , We will provide an interior fence and enclosure around the pool as
required by the Glendale Pool Barrier Ordinance.
B. D 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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41- 6aLI Li
IF YOU CHECKED BOX II B, PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1. ❑ The pool shall be protected by a motorized safety pool cover.
2. ❑ Doors and windows are protected
3. ❑ The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. El The above ground swimming pool shall have a secured ladder.
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
LiAnA Krug TA( _ 5/2la°
Name of Home Owner me Owner Signature Date
ke, Lillis ` >l �5/4i E
Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa On this 0\ day of IOLI,
, 20 ) , before me, personally appeared
UqlOk Zy,At (name of signer), whose identity was
proven to me on the bas f 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.
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ftflO & , Oa 4 �'r., OPPIBUI SEAL
..,r.. PAULA M. CLARK
U NOTARY INC-State of Arizona
MARICOPA COUNTY
My Comm.Expires July 24.2014