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c Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date 10 ZOO
Property Address 4 0'�. , C�rl, biwt 'J . � Ie A2 ��7, '?� -- f G� SIG .�
Name of Property Owner L y L \TTAvA2.'t LC
_ S
I. 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 H 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. D Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the Building Official
Atttk'EC C •
Name of Home Owner H j3i., ' • Signature Date
i/Oo / , ter
eled , /t7
Pool Contractor Contr;ctor Sig,ature Date •
SIGNATURE OF OWNER MUST BE NOTARIZED
KARLIN ROSE MCKIBBEN
Notary Public-Ariz.,
State of Arizona I J mmis ion Court.,2 i
,�'� � Commission�5652i9
My Comm.Expires Jul 23.2023
County of Makicopa
On this ii4day of , 20 r9 , before me, personally appeared
l (name of signer), whose identity was
proven to me on e 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/ "c a ocument.
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