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�► GLENDALE, ARIZO �A
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20635 N. CAVE CREEK ROAD I alb�' I"-2 -0"
PHOENIX, AZ 85024
B5 ROC 094365
Br:602.569.6336. OFFICE � - - O 5 I( 20
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CUSSOMER NAME NANGY MATTHEWS SPA SPEC\F\CAT\ONS ?00_ SPEC\F\CAZ\ONS CROSS SECTION
ADDRESS 62161 N. 43RD. DRIVE AREA AREA 3'15
C\TY 6LENDALE 72 CODE 35302 pER\M PER1M SO -
NOME PNONE go. ?NONE 602-•461q-1844 GAU_ONS GAl10NS 11,250 3 5 4
?Ma # I48-I I-O85 SOT # DI
SUems\ON SANDS OASIS \.A. \.A. 6615
DECK DECK 300 , - 14 C ' II 0
Joe # 2115A DASE 5-23-161
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RESIDENCE FINISHED FINISHED
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POOL SHELL
YARD SECTION A
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CUS1OMER NAME NANCY MATTHEYVS
ADDRESS 8211 N. 43RD. DRIVE
cm 6LENDALE 11P CODE 85302
HOME PHONE A\_7. PHONE 6O2-414!-7844
PARCE\_ # 148-II-O$5 \01 # 81 PERMIT 6LENDALE
sUeolvlsn% SANDS OASIS 1S1 DRAW 5-23-11
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20635 N. CAVE CREEK ROAD
PHOENIX, AZ 85024
B5 ROC 094365
A 6-18-11 602.569.6336• OFFICE
602.569.9162• FAX
WWW.DOLPHINPOOLS.US
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Community
GLENDili,,E Development Group .
NEW SWIMMING POOL PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
• Please type or print
Date
Property Address
Name of Property Owner Na 14 114.4d-h i 05
I. 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 o secondary_ pool protection).__: __
A. .riZ 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.
-13
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. El The pool shall be protected by a motorized safety pool cover.
2. ❑ Doors and windows are protected
3. 0 The-pool shall be protected by-an-alarm maintained in or on the
swimming pool
4. El The above ground swimming pool shall have a secured ladder.
5. 0 Locking hard safety cover on the spa or hot tub.
6. El Alternative protection not specified above which is attached to the
plan submittal and submitted for approval by the Building Official
(A vj i'ncE, q C-4A_t2 )/iaciAvi,t,os S 17A iq
Name of Home Owner Home Owner Signature Date
lf \U1 5i ( 1
Pool Contractor Contractor Signature Date
' ✓tl BARBARAJEANDOR8IN'::
Notary Public-Arizona
02.�^ e— MancooaCounty - -
SIGNATURE OF OWNER MUST BE NOTAR171 v My Corr X,,;es Dec 28,2021
' State of Arizona zoz na dsa,id>3 w0-cb w
'
ptmo5.eawuew
a,;zuy 5ilggd f.e;oN,
Mart} Y2lVBi ,, •
County of Maricopa `
- On this 0.7 day of LicriGulf , 20 I . l , before me, personally appeared
AC (flet i-kse1,(,9 s (name of signer), whose identity was
proven toe 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.
14