HomeMy WebLinkAbout83597 . r . #035 , -7
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GLENDf Development Group
NEW SWTMIVIING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date -3 d -
Property Address 7( 0 g vi4- 4 u.14_
Name of Property Owner /404/VG-- ��' A,
I. 1No 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 the 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.
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IF YOU CHECKED BOX II B,PLEASE COMPLETE REVERSE SIDE
WHICH IS THE NEXT PAGE IN THIS DOCUMENT
THIS IS THE REVERSE SIDE OF THE PREVIOUS PAGE
1_ 0 The pool shall be protected by a motorized safety pool cover.
2. 0 Doors and windows are protected
3_ 0 The pool shall be protected by an alarm maintained in or on the
swimming pool.
4. ❑ The above ground swimming pool shall have a secured ladder.
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
Name of Home Owner Home Owner Signature Date
S� 7 4,e-S � `p `3°-/ I
Pool Contractor Contractor Signature Date
SIGNATURE OF OWNER MUST BE NOTARIZED
State of Arizona sandx3 uo!ssluiwa0 As.
VNOZ111V'Dn8nd AMON
County of Maricopa NOSdWOHJ 13Ndr -
On this ay of Nia-✓ -e. _ , 20 /!. before me, personally appeared
` Dam ! /Cct.v\ (name of signer), whose identity was
proven tb.ine on the basis of satisfactoryevidence to be the person whose name is
subscribed to in this document. and who acknowledged that he/she signed the
above/attached document
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