HomeMy WebLinkAbout118169 /6 7
Community
GLENI1,E Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date q(g I (cl
Property Address 23S3 I 0 _ M'tPl-s.v( 64C
Name of Property Owner 2.0}-ER,p t , ter ( YA-6.)
I. 11' No 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 pool protection)
if 3 � � .� Nye provide an interior fence and enclosure around the pool as
i.3 ,c .; ,required by-,the Glendale Pool Barrier Ordinance.
will provide exterior fence and enclosure protection with
'''' --secondary-protection as checked on reverse side of this affidavit per the
Glendale Pool Barrier Ordinance.
loft
IIS1a9
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. Cl The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. ❑ 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
Zit(sC•li Ara)PV1 il/C1 5f zhct
Name of Home Owner Home Owner Signa e Date
OHMS-CA . '--- S/2l r'7
Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NerTT J NA }ss
of-COON I Y u MI RICOPA
State of Arizona ,v`ljtr, GREG M. SCHAFFRAN This instrument was acknowledged before me this Zilv day,f
Notary Punk-Stated Artois 20 L 9 by
w, �y MARICOPA COUNTY
sr ., Co„ftwon 0 567178 In witness whereof I herewith set my hand and official seal.
County of Maricopa _ a.��s* dxpuos t» 13,202 � t s— NOTARY PUBLIC
-Ire- I '2, -2-o'Z z Expires
On this 7,,a day of /tA , 20 j (2 , before me, personally appeared
7e, L r 436 A ti,"A&Aye (name of signer), whose identity was
proven to me on the basis of 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.
2 of 2