HomeMy WebLinkAbout78496 ?CS-A^ 4-44 7E4/ ‘
ria6riPpisum Community
GLENDfl Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Please type or print
Date .77 3oo/i 5
Property Address 76 00 (4• Kra -Of— &CFLA3DALL t a53D3
Name of Property Owner �. j( tiotle
L1L1�
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.
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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. ❑ The pool shall be protected by a motorized safety pool cover.
2. 0 Doors and windows are protected
3. El 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. ❑ Locking hard safety cover on the spa orhot tub.
6. ❑ Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the Building Official
—ADD I i1,412.514,6LL_c _41>QLQ2„.
Name of Home Owner ome Owner Signature Date
PALArop431/S. tOLL
Pool Contractor i't actor Signature, Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona WENDY POWERS
:ter Notary, Y Public—Arizona
County of Maricopa .� Pilwitopa County
• • biRres on 01J31JI014
On this3O day of Lt.\1 ,20 l3 , before me, personally appeared
U)S �{ SL (name of signer), whose identity was
proven 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.
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