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1114:W SWII a sir 1G FOOL PLAN SUBMITTAL A11741rW,VITTi
Ordinance#2.6
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Date \lit
Property Address %AC\ ' __- g4,0</C , IV 3().2
Name of Property Owner 5 _, , O
T. No children less than six years of age reside at this address.i(
11. 0 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. 0 We will provide an interior fence and enclosure around the pool as
'required by the Glendale Pool Barrier Ordinance.
B. p,-ode will rovide eS€terior`ace and enclosure 'L
._... ..._. _? �. protect' with
secondary protection as checked on reverse side of this affidavit per the
Glendale Pool Barrier Ordinance.
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WIPIICART IS TYE NEXT iFuA,311 13( CUI'L I ii
T US ITS T FTE REVERSE ERSE SIDE OF Ti I-1 i , PREVIOUS PAGE
I. ❑ 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. LI Locking hard safety cover on the spa or hot tub.
6. ❑ Alternative protection not specified above which is attached to the
plan submittal and submitte for app val by the Building Official
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Name of Home Owner for Owi _ ignature Date
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161 1Y
Wool Contractor Co_ - or Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona BARBARA JEAN DURBIN
Notar.\vr� MARI(APW COUNTY
County o f Maricopa kV Commission Expires Dec.29.2017
On this /`:) day of f lOA , 20 / 4 , before me, personally appeared
p(, 0 FuYnicm ct c. (name of signer), whose identity was
proven toe 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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