HomeMy WebLinkAbout119881 // q1g /
Community
GLINDfE Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Please type or print
Date Sj Id/19
Property Address 3:, V Q�C 1S fi d 02,
Name of UProperty Owner M VS M6 < uJ
I. FC--No children less than six years of age re ide 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. ❑ 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.
IF YOU CHECKED BOX II B, PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
r t
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1. 0 Jhe pool shall be protected by a motorized safety pool cover.
2. E( Doors and windows are protected
3. 0 The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. 0 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 abo e which is attached to the
plan submittal and submitted • •pprova by � - :uilding Official
Id
e (Yla( ' r _EWA__
Name of Home Owner Hom go, er : s ature Date
ThUr & )(14 2nuLS AL.., 4. -4-11-9---
Pool Contractor Co is .ctor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
•
County of Maricopa
On this i St day of , 20 I1 , before me, personally appeared
ail Mal/Or U (name of signer), whose identity was
' oven to me on the basi�pf 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.
RIM0 '123 I
Cu �� -
(Seal) No ry Public