HomeMy WebLinkAbout83448 (2) 31� r8
City of Glendale
GE Development Service Center
_ _ SWIMMING POOL
BARRIER AFFIDAVIT
Ordinance#2046
Please type or print:
Date ?///b •
Property Address / ep
Name of Property Owner z.2 e 4S U r7
I. ;K__ No children less than six years of age reside at this address.
II. [ 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. ❑ 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 reverse side of this affidavit
per the Glendale Pool Barrier Ordinance.
(Complete Reverse Side)
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41,
City of Glendale
41111
GIE\WDevelopment Service Center
❑ 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 a 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.
d2je'r. SOki
Name of Home Owner (Print) Home wner Signature Date
Pool Contractor (Print) Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona
County of Maricopa
On this I It day of ��A�, , 201,14 , before me personally
appeared Tec kk SAP ckss car\ (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.
Notaryblic Pu State of Arizona
`�' Mancopa County
•o , Dawn C Slater
�` r My Comrrmsson Expires 02/02/2018
(Seal) Notary Public
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