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NEW SWI A ]1]I'IG POOL PLAN SUBMITTAL AFFIDAVIT
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Ordinance#2046
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Date Wi!, 'ti
Property Address G&) C GI (A (( -f7 , /C-.
Name of Property Owner in I -41, k) ' /,'r. ! ,r
k. ❑ No children less than six years of age reside at this address.
H. fr A child under the age of six years of age resides at this address.il..„.
(If this box is checked, identify method of secondary pool protection)
A. ❑ We will- rovide an interior fence and enclosure around the pool as
{ i+oAUO MA%ARAtee irted by the Glendale Pool Barrier Ordinance.
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rn+,.a� We.will provide exterior fence and enclosure protection with
Vet.aS. 1 noviceel Win.. `
- secon�Cary protection as checked on reverse side of this affidavit per the
Glendale Pool Barrier Ordinance.
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WE CIE S T1 HIE NEXT iyAt: E TIN 71-FIS D CI�UTVI N
THIS`1LS 'WS TD 1:-1: REVERSE SIDE 07+ L Hsi��, PREVIOUS i WOUS PAGE
l. ❑ The pool shall be protected by a motorized safety pool cover.
2. Doors and windows are 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 secured ladder.
5. ❑ Locking hard safely 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
4/4^-i1/(IL TZIND(1
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Name of Home Owner Home Owner Signature Date
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Pool Contractor Contractor Signature Date
SIGNATURE_.E OP OWNER MUST BE NOTARIZED
State of Arizona
BARBARA JEAN DURBIN
County of Maricopa k, J r c•8leCOUNTII
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AMRICOPN
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On this C) day , 20 I , before me, personally apea ed
TDC04444.(k) Ian° 1 I (name of signer), whose identity was
proven 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.
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