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aEND,p Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print Date I J in/0Z
Property Address q 3s b t knr(p lQ Av 6inLt4 AZ e-5so3
Name of Property Owner 6 kin ( le Likocibe,v
I. pt( No children less than six years of age reside at this address.
IL C.I Asbilliunder tja .age of six years of age resides at this address.
(If this box is checked, identify method of secondary po�'To pro on)- -- -
A. 0 We will provide an interior fence and enclosure around the pool as
required by the Glendale Pool Barrier Ordinance.
B. 0 We will provide exterior fcnce and enclosure protection with
secondary protection as checked on reverse side of this affidavit per the
Glendale Pool Barrier Ordinance.
13
IF YOU CHECKED BOX II B, PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1. ❑ The pool shall be protected by a motorized safety pool cover.
2. p Doors and windows are protected
3. 0 The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. p The above ground swimming pool shall have a secured ladder.
5. 0 Locking hard safety cover on the spa or hot tub.
6. 0 Alternative protection not specified above which is attached to the
plan submittal and submitted for appr val the Building Official
1-7 /202 )
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Name of Home Owner •ome Owner Signature Date
SG.yc; Ca.-for\ 3/z/zoza
Pool Contractor C rector Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this 1day of 161 , 2Q , before me, personally appeared
Cj he J. 0md L . L- ache of signer), whose identity was
proven to me on the basis of satisfactory evidence to be the person aA a name is
��N hip i
subscribed to in this document, and who acknowledged that he h09Qnd�
above/attached document. �` 4.NO,
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