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GLENIIE Development Group
NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
Please type or print
Date I g t I 14-
Propert Address' 4013 IA/ /U O V t _ tA) .
£ '
Name of Property Owner C, 44ts ("I q)
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I. X No children less than six years of age reside at this house.
II. ❑ A child under the age of six years of age resides at this house.
(If this box is checked, identify method of secondary pool
protection.)
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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 page two of
this affidavit per the Glendale Pool Barrier Ordinance.
(COMPLETE OTHER SIDE)
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Community
GLENff Development Groupp
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. ❑ 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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4arftPL--‘P 1
Name of Home Owner(Print) ner Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
H-eaxo be ikc t Il sjiqPool Cotor(Print) on for S. ture Date
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State of y tel: County of art'
Subscribed a;.'<before me-. 021
(Note Signature)
Judith Pelkey
"` wil _ Maricopa C Notary Publicounty on
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Page 2 of 2
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