HomeMy WebLinkAbout80643 ecke--/J
„Atm City of Gl
GI Development Service Center
NEW SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date / —
Property Address ,c3 t 7 LACJ r i - Qv2
Name of Property Owner , ZJI N k/t7
La No children less than six years of age reside at this address.
IL n 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.
�iri . Kt i
YnquipoaPtore
444
Vet,et.00er��
va
(Complete Reverse S
Page 1 of
Dy
.;9464117.,
Glendale
of
Developrncnt Service Center
❑ 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 alai in 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.
1 6. Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the building official.
gellv
Name of Home Owner(Print) Home Owner Signature Date
AY-PHI Ai POOLS/ OsT (kith i-f 4I li 11 i 3%',
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this ) 3 day of T01..X1 , 20 , before me personally
appeared L_`,--Q,/Q (G4 (name of signer), whose
identity was proved to �e 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.
BARBARA JEAN DURBIN
"Mg eft CiAdaDai
+1.1.-07 AVOstalwasise elphveC°Ulloorrie,2017 Llejakb et.
(Seal) Notai ublic
Page 2 of 2