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Ire Community
Gump Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date //3! /i
Property Address 7s3-0 „v eflie4-1 I f}it
Name of Property Owner Ckiti ,e/L -P2
I. (d' No children less than six years of age reside at this address.
II. 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. 0 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.
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IF YOU CHECKED BOX II B, PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1. 0 The pool shall be protected by a motorized safety pool cover.
2. 0 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 above which is attached to the
plan submittal and submitted for approv: • he Building Official
Cht2.45 ?eagl * / 4,
Name of Home Owner Horn, O.• : • • .ture Dat•
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Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this day of , 20 / , before me, personally appeared
(VMS( fin-I( (name of signer), whose identity was
proven 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/slcsigned the
above/attached document.
•'''%� Shanon L.Rice 14
*. ., NOTARY PUBLIC-ARIZONA
v Y �) MARICOPA COUNTY
`f+ My Commission Expires
August 12,2016
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