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Community
E
Development Group
NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance#2046
PIease type or print
Date gJI'l�1�
Property Address 46,21 W. WIEY lkrl�
Name of Property Owner NZ,‘(1..,
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 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.
(COMPLETE REVERSE SIDE)
Page 1 of 2
g�
i Community
GLEN E
Development Group
1 . ❑ The pool shall be protected by a motorized safety pool cover.
2. \ Doors and windows protected.
3. 0 The pool shall be protected by an alarm maintai -d in or on
t•e swimming pool.
4. 0 The a.•ve ground swimming pool shall h. e ladder secured.
5. 0 Locking ha d safety cover on the sp. .r hot tub.
6. ❑ Alternative prot:ction not spec. 'ed above which is attached
to the plan submit 11 and sub, itted for approval by the
building official.
Name of Home Owner(Print) Ho Owners Sign.tore Date
Pool Contractor(Print) Contractor Signature Date
SIGNATU I F OWNER MUST B . NOTARIZED
State of Arizona
County of Maricop
On this day of_ , 20 , before me personal appeared
(name of signer), whose identity wa .roved to me on
the basi of satisfactory evidence to be the person whose name is subscribed to this document,
and o acknowledged that he/she signed the above/attached document.
(seal)
Notary Public
Page 2 of 2
19101 .
r pi
Community
GLENL-��- E
Development Group
1. ❑ The pool shall be protected by a motorized safety pool cover.
2. 0 Doors and windows 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 ladder secured.
5. 0 Locking hard safety cover on the spa or hot tub.
6. 0 Alternative protection not specified above which is attached
to the plan submittal and submitted for approval by the
building official.
r_z_H\
Name of Home Owner(Print) Home Owners Si
Pool Contractor(Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this /4 r" day of Eh £ -• , 20 (3, before me personally appeared
�1G �4 (name of signer), whose identity was proved to me on
the 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/attached document.
(s • ; Jane L.Thompson
NOTARY PUBLIC-ARIZONA 7No—ry
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MARICOPACOUNTY.•�� My Commission Expires
March 02,2014