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Community
Development Group
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NEW SWIMMING POOL
PLAN SUBMITTAL AFFIDAVIT
Ordinance #2046
Please type or print
Date %'7- a'90,
Property Address '?j
Name of Property Owner Q ✓ S r� oy �e
I. V 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- c ,ecked; itlentify' method uf-Secondary pool pratectiun.)
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.
(COMPLETE1
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REC') SEP 2 g 2006
Community
Development Group
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 ladder secured.
5.
❑
Locking hard safety cover on the spa or hot tub.
6.
❑
Alternative protection not specified above which is attached to the
roval by the building official.
plan submittal and submi:Zi�'/'
aZ6 �r s_ F/o 4- 9-�-0,
Name of Home Owner Print) ' Home Owner Sifnature Date
pa.aao&k
Pool Contractor (Print)
Contractor Signature Date
-SIGNATURE OF OWNER MUST--BE=N�'rA�?
State of Arizona
County of Maricopa
On this day of 20OU , before me personally
appeared S • (name of signer), whose
identity was proved to me on t e 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.
(seal) IM w - Y!EOF �i► °M" ..
s Notary Public