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HomeMy WebLinkAbout120495 1 a? (---t 9S- GL ErJItE NEW SWIMMING POOL BARRIER AFFIDAVIT Ordinance#2046 Please type or print: Date g a ZU r Property Address c8 L(2 ( uJ• 11-0 c U c M ✓L' C�.. (,Et'P6-(E A-2 8 S3 0 Name of Property Owner ESTO © fr t Z 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. ❑ 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. (Complete Reverse Side) City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599•Phone(623)930-2800 www.glendaleaz.com eit lb GLENEV ❑ 1. The pool shall be protected by a motorized safety pool cover. IS;, 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 a 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. e. 6.1-O 021-C cs:TO ©irt g /2-8009 wi 10 o‘2.111, Name of Home Owner(Print) Home Owner Signature Date /4 Pool Contractor(Print) Contractor Signature Date SIGNATURE OF OWNER MUST BE NOTARIZED State of Arizona County of Maricopa On this xr day of Ater , 20 v', before me personally appeared Erhe.a\--o 0 r4-i L. (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. --- -- — - - -- i., s,r IULEYKA DUAFiE ( Notary Public-Arizona Mancopa County Commission 9 564215 ' My Comm.Expires May 26,2023 (Seal >c City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599•Phone(623)930-2800 www.glendaleaz.com