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Home My WebLink About81827 - 5A-120 al Community Cl Development Group NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT Ordinance#2046 Please type or print Date 3 ` 2 5 - 1 Propert Address' \ f 15 LA), I�Ob(v LaKQ Name of Property Owner 1- 6-e I re"ts I. g No children less than six years of age reside at this house. II. L A child under the age of six years of age resides at this house. (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. 0 We will provide exterior fence and enclosure protection with secondary protection as checked on page two of this affidavit per the Glendale Pool Barrier Ordinance. (COMPLETE OTHER SIDE) Dr. i .,F 7 r Community G� 4,74 Development Group 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 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. KJ)(1- Be14(?0S 3 - Z5- ) Name of Home Owner(Print) Home Owner Signature Date SIGNATURE OF OWNER MUST BE NOTARIZED Pool Contractor(Print) Contractor Signature Date Page 2 of 2 r 9 INDIVIDUAL ACKNOWLEDGMENT State/Commonwealth of 0-OCNCk �,, " ss. County of 1 X `IJs\ C U' On this the 0/5 day of MCA.00\ ,oi_U 1U` , before me, NDay 1 ,, W _ Month Year \( UL cod/N 1� , the undersigned Notary Public, Name'of Notary Public 1 personally appeared W(�(ilr-i— �\1'i \c-C , Name(s)of Signer(s) ❑personally known to me- OR - ❑v'proved to me on the basis of satisfactory evidence to be the person(s)whose name(s) is/are subscribed _,,,I NICHOLE WANNINGER to the within instrument, and acknowledged to me ,, Notary Public'Arizona that he/she/they executed the same for the purposes Y ComMaricopa County therein stated. • � M m• Expires Aug 28,2016 WITNESS my hand and official seal. i Signature of otary Public ' `Vll9� atlJ�� U Any Other Required Information r.Place Notary Seal/Stamp Above (Printed Name of Notary, Expiration Date, etc.) INFORMATION IN AREAS 1-4 REQUIRED IN ARIZONA. OPTIONAL IN RIGHT RIGHT OTHER STATES. THUMBPRINT THUMBPRINT OF SIGNER#1 OF SIGNER#2 Description of Any Attached Document ` ''` Top of thumb here Top of thumb here 1 Title or Type of Document:�W'�`(I,YYL1AY'U �W� O_ C- v J 2 Document Date: �3)zr 1I'l 3 Number of Pages: Q. 4 Signer(s) Other All I Than Named Above: ©2011 National Notary Association • NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#25936 ir. / ' . . . .„ . , . . -, -.,-,, ; '-, >••! .41fr ..46;-.....11 r'll',All-' : ,-.c)*).S IN•:I'..j.':,, .., ' , , ' • ., ,;., 7.3•(-0 . . , . ,,...4.,..lie.". ......_..1.:. , . . • ..• . .,. •. , . , i • -. . . • ,.• •. . ..• , . . 1 ..• ••••' °.. - #. ../... n 1 i . I . I., 'i.-',.!•1•,i:_ „, I I 1. . 1.... ' . - ... . .