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4411 "1 4 Development Grou
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NEW SWIMMING POOL -
PLAN SUBMITTAL•AFFIDAVIT
rdinarce#2046•-
Please type or print;
Date U l VI Z.olLI - • •
Propert Address ?y LQ I 1 4 -wsio,-WiPr. entia
Name of Property Owner MU I ► l ?)Ir14n C.l Y1( •1 • •
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I. 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.
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• (COMPLETE OTHER SIDE)
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Page_ 1. of 2
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- : .•.:• , • ' EL1 I. -'-:. . . 1: '4k: - --- . si -. ,• . ..::: Development Group ''''''' •••••:' .• ''
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.. . ... • ....; -.. .. 1 ❑ The pool shall be protected by•a motorized safety pool cover '
2. El . 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. El 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.
+ Erian 11ltiil - . .
Name of Home Owner(Print) Home Owner Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED V -
• Pool Contractor(Print) - . Contractor Signature Date
. WENDY POWERS .
l�) Notary Public
— '461a
- • mr• bores ion 08/31/2014 V -
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