HomeMy WebLinkAbout81259 4.zz g/c)- Y-
City of Glendale
(L Development Service Center
NEW SWIMMING POOL
RARRTER AFFIDAVIT
_ ._ finance#2046
Please type or print:
Date
Property Address \9-9/7 iV 1 O O/Md0 DIZ 6/tit7a, I.
Name of Property Owner 6/16 2.( L C.(7<J 2 D///4
I. ❑ 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. 0 We will provide an interior fence and enclosure around the pool as
required by the Glendale Pool Barrier Ordinance.
B. P( 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 len . , e •
GLENFIE Development Service Center
❑ 1. The pool shall be protected by a motorized safety pool cover.
2. Doors and windows protected.
-- ❑ --- 3.-` ht—pool-sh l b-e-protccted-by an-al the
swimming-pool..
❑ 4. The above ground swimming pool shall have a ladder secured.
O 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.
,P`pbict qczok
\Name of Home Ownrint) Ho Si ture Date
Pool Contractor(Print) actor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this A day of -e 1\ r `'1 , 20 H, before me personally
appeared L1c .(oc; -\ CV' " q0\ (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.
Jose Rivera
Notary Public
s,' MatrTcopa County,Arizona
My Comm.Expires 10-14.17
(Seal) Public
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