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Home My WebLink About76966 Community • ahrirrDevelopment Group �I NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT Ordinance#2046 Please type or print Date G- -7D3 Propert Address' tON6 PO-kr" Or-WIZ GjkAkQ Z ,SCSoK Name of Property Owner Mad a)SCQV\ I. ►i1 No children less than six years of age reside at this house. II. 0 A child under the age of six years of age resides at this house. (If this box is checked, identify method of secondary pool protection.) A. 0 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 page two of this affidavit per the Glendale Pool Barrier Ordinance. (COMPLETE OTHER SIDE) . j• • 1j t! - i.' sS 11%tJli rt• i rt lr � n'� .'r`,i7 iF� '1`I ::(se �. �•: • • 9 %Go. X ,60 Community �i Gr Development Groupp 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 alarm maintained in or on the swimming pool. 4. ❑ The above ground swimming pool shall have 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. l 0Q6‘ 5VicIS' ? -(3 acne of Home Owner(Print) Home Owner Signature Date SIGNATURE OF OWNER MUST BE NOTARIZED Pool Contractor(Print) Contractor Signature Date Page 2 of 2 INDIVIDUAL ACKNOWLEDGMENT State/Commonwealth of IV r /'Lek_ ss. County of ')11u l)coca-- On this the �p? Li"- day of �f 0��3 , before me, //�� Day / / Month Year Po ie. 7. /c fCf(v...444.5 , the undersigned Notary Public, Name of Notary Public personally appeared 5 USuw\ r -f1LQ� Name(s)of Signer(s) personally known to me - OR - proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument, and acknowledged to me that he/she/they executed the same for the purposes therein stated. WITNESS my hand and official seal. 4 �01"1,,,, PAULA M.ANDREWS �� • ��_ 4 w�, Si nature of NotaryPublic J,-, , Notary Public-Arizona � Maricopa County My Comm. Expires Feb 22,2016 Pmewearisrouneanwimplepoimposonermapei £.422a. Any Other Required Information Place Notary Seal/Stamp Above (Printed Name of Notary, Expiration Date, etc.) INFORMATION IN AREAS 1-4 REQUIRED IN ARIZONA. OPTIONAL IN RIGHT RIGHT OTHER STATES. THUMBPRINT THUMBPRINT OF SIGNER#1 OF SIGNER#2 Description of Any Attached Document Top of thumb here Top of thumb here Title or Type of Document: /4 uvi� r-e /�/d rld r::: Document Date: 5 ,) ' l 3 Number of Pages: " a Signer(s) Other Than Named Above: ©2011 National Notary Association • NationalNotary.org• 1-800-US NOTARY(1-800-876-6827) Item#25936