HomeMy WebLinkAbout83699 City of Glendale
GLEMIE Development Service Center
030?
_ SWIVIMENG POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date /,'L
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Property Address �� (n/- Le (K c 1�vt S D 6/e,d1c,IJ S3-30K
Name of Property Owner 120 er`t ,� to
I. No children less than six years of age reside at this address.
u 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.
(Complete Reverse Side)
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City
of Glendale
GLENP Development Service Center
❑ 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 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.
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Name of Home Owner(Print) Home Owner Signature Date
Pool Contractor (Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this / of , 20 &before me personally
appeared 6 Lef-- S (name of signer), whose
identity was proved to me on the basis of satisfactory evidence to be the person
whose name is subscribed to in this documen acknowledged that
he/she signed the above/attached docume
`, ELIZABETH R.MEDWID
Not-ry Public -Arizona
Maricopa County
• 9, •- iGy gKn.Expires May 25,2015 llbllC
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