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Community
Development Group
•
NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Please type or print
Date CO 11 I 1 d
Propert Address IGJ(LO (A) - (CIO Ct U 1 0, Nelvic)ic c:6C
Name of Property Owner -9 Pam ' warr
I. No children less than six years of age reside at this house.
II. A child undet the age of six years of age resides at this house.
(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 page two of
this affidavit per the Glendale Pool Barrier Ordinance.
(COMPLETE OTHER SIDE)
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GLENDfE Development Group
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 alarm maintained in or on the
swimming pool.
4. ❑ The above ground swimming pool shall have ladder secured.
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.
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Name of Home Owner(Print) Home Owner Signature ate .
SIGNATURE OF OWNER MUST BE NOTARIZED
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Pool Contractor (Print) contractor Si ature Date
, ANDREA K. MARTIN
klv } )1 NOTARY PUBLIC-MQONA
.ate,% My Comm.ExP.:Apn72Y,2017
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