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City
of
GLENrIE Development Service Center
NEW SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance 42046
Please type or print:
Date —15- iG/
Property Address c5-014 (' rncnlWa4- m2
Name of Property Owner kkan a d JI ii gL&eE "
I. No children less than six years of age reside at this address.
IL 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. _ 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.
144.4 Ain 14A AfiAr::
(Complete Reverse ' y
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�4111 , City o Glendale
qii
5i Development Service Center
❑ 1. The pool shall be protected by a motorized safety pool cover.
1 2. Doors and windows protected.
❑ 3. The pool shall be protected by an alarm maintained in or on the
swimming pool.,
1 4. The above ground swimming pool shall have a 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.
kgwiv owl 1-6)1 th.. o 44 fie. g G-1- a-J5 - 1
Name of Home Owner(Pr t) Home Owner Signa. = Date
Ot/IOPIhr Qexs i—s 15- 'y
Pool Contractor (Print) Con j or Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this J_, .1 day of 40,COULk(Luii , 2019, before me personally
appeared �� (� /g ib� 1h - (name of signer), whose
identity was proved to me on the baks 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.
IS
BARBARAJEAN DURBIN
.ftaicoPA COUNTY
414)
Mi►CaneiNon Expires Din 20.NIT (52Cedjell(a- ..
(Seal) Nota u
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