HomeMy WebLinkAbout81064 'Pit% City of Glendale
Mi
GI-El\lp Development Service Center
SWIMMING POOL
BARRIER_ AFFIDAVIT ,
Ordinance#2046
Please type or print:
Date ' 90- It-)
Property Address T ) 5G vo may )ce G-Ikv\doJ i )-2 3O3
Name of Property Owner t V ( (d Le ( a,vy y-\___
I. No children less than six years of age reside at this address.
‘'-'9()
IL 0 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. 0 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)
Page 1 of 2
FldGj
ii,
r.,21, City of Glendale
Mb
GLEMIE Development Service Center
L 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 appro 1 by the building official.
I a l E (Ck‘ir\M t 2 Zo-t51
Name of Home Owner (Print) Ho e Owner Signature Date
Pool Contractor (Print) Contractor Signature Date
i
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this 02(.) day of L {2\ , 20 i`{', before me personally
appeared J L ii(C ( W t.-4_ (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 document, and who acknowledged that
he/she signed the above/attached document.
wri' GREGORIO PEREZ
NOTARY ONA
ricope County
0l Qr j
v
`�' Commission My Comssion Expires
d August 04,2017 ( \
(Seal) Notary Public
Page 2 of 2