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0111, Community
aElbfFel Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
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--Date
Property Address 917 2- IQ OW hEA
v 6 S
NameooirtYOwner L1 6LCt
I.
:::\r:r No children less than six years of aRe reside at this address.
II. 0 A child under the age of six :v ears of age resides adrs
(If this box is checked. identif:, method of secondary pool protection)
A. El We will provide an interior fence and enclosure around the pool as
required by the Glendale Po o; Barrier Ordinance.
B. D We will provide exterior fe7ce and enclosure protection with
secondary protection as checked on reverse side of this affidavit per the
Glendale Pool Barrier Ordinance.
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IF YOU CHECKED BOX II B, PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
a
a
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1. 1 1i T pool shall be protected by a motorized safes pool cover.
2. Doors and windows are protected
3. 0 The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. LT The above ground swimming pool shall have a secured ladder.
5. _.] Locking hard safer 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
Name of Home Owner Home,O vner Signature Date
ram L T Pds 11,0 _— —
Pool Contractor Conti actor Signature r)-arc
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona.
County of Maricopa
(.)n this r day of_Aid L'1M t/L . 20 / before me. personally appeared
(name of signer). whose identity was
proven Atte 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.
OFFICIAL SEAL.
•.;11t:,CONNIE J. WATSON
J 'NOTARY PUBLIC•State of Arizona
• "%e." ICOPA COUNTY
.r4Q tied, �gaplreta Fab:2$,2016 Notary Public