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Pt Community
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GLENp Development Group
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
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Ordinance #2046
Please 'type or print
Date _ - —
Property Address (P 6 6 7 /A) . GGo Weil Li)L .
Name of
I.. No children less than six years of age reside at this address.11C
11. 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. Li 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 -filitg
secondary protection as checked on reverse side of this affidavit per the u-
Glendale Pool Barrier Ordinance. ,..,.;,.
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IF YOU CHECKED BOX If B. PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
i� The pool shall be protected by a motorized safety pool cover.
2. ❑ Doors and windows are protected
3. 0 The pool shall he 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 or hot tub.
6. Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the Building Official
Name of Home Owner, Flo - !°. • Si ature Date
< Mr' („) ..
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Contractor Contractor Signature Date cg
'.. SIGNATURE OF OWNER MUST BE NOTARIZE '.
State of Arizona ;
County of Maricopa
On this t eN day of e- 20 I , before me, personally appeared
P e4n 1340W 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 acknowled:ed that he/she signed the
above/attached document.
TtANA R.:SMrrH 14
• NOTARY PUBLIC!,Shte of Arizona
MARICOPA'COUN1Y
�• Commission 10•
. 553054
My Comm,Expires September 10,2022 . .,,.