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E
Development Group
NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Please type or print
Date /0/
Property Address 719:c . 0 ie / i / J�,2
Name of Property Owner (,t)/ L L/ 5
I. X 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.)
A. ❑ We will provide an interior fence and enclosure
around the pool as required by Glendale Pool
Barrier Ordinance.
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.
(COMPLETE REVERSE SIDE)
Page 1 of 2
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iii Community
GLEN> E
Development Group
I. ❑ The pool shall be protected by a motorized safety pool cover.
2. 0 Doors and windows protected.
3. 0 The pool shall be protected by an alarm maintained in or on
the swimming pool.
4. 0 The above ground swimming pool shall have ladder secured.
5. 0 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.
td/iha' ki-t P 0-e,s- (AILL:A4.-1 i 1 f / • :• 10/1/2_,0 /?
Name of Home Owner(Print) Home Owners Signature Date
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this y day of X2eiate.Z , 20 , before me personally appeared
/1'J/Mom satisfactory evidence to be the person whose name is subscribed to in this document,
and who acknowledged that he/she signed the above/attacher. :ic • ent.
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Notary Public-Arizona
Maricopa County
."+1�' My Commission Expires I
April 22,2017