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rirre Community
GIFND*E Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date (p /e/1 3
Property Address 7 5 71/ W - Cky s-14-,_ QD . C,LE J At F, Al_ 2 3c
Name of Property Owner Tutz i r _ CAA-HA-WI
I. 0 No children less than six years of age reside at this address.
II. k2K 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
re red by the Glendale Pool Barrier Ordinance.
B. V 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. Cy The pool shall be protected by a motorized safety pool cover.
2. d Doors and windows are protected
3. ❑ 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. ❑ Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the Building Official
C.11;4- billabrct .3Y --- ja18"/1_3__
Name/ /of Home Owner Home Owner Signature Date/ /
,rivi,e( Ms-f'&,n4.5-442_ a...,..-L5 4.,e ,--7
Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this '7114 day of�UM, , 20 )5 ,before me, personally appeared
PUY\ ik 0_ A,o rp , (name of signer),whose identity was
proven to me on the basis of satisfactory evidence to e the person whose name is
subscribed to in this docume t and vho acknowled that he/she signed the
above/attached document. /,�,t_i 4v"v 14
i s aro KIMBERLY WINTER
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I r NOTARY�( PUBLIC-ARIZONA
- i.'+4 Maricopa County
" d' .. M Commission Ex Expires
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August 5,2015