... in alternate formats (Braille, large print, computer diskette, or audiotape) upon request. ... code or zoning ordina
Pool, Property Survey waiver In lieu of obtaining a survey as required for new structures built less than 2 feet from or into any required building code or zoning ordinance setback, this waiver may be completed and submitted with the swimming pool permit application. This form can be made available in alternate formats (Braille, large print, computer diskette, or audiotape) upon request. Contact the Development Services Department at (602) 272-7811 (voice) or (602) 534-5500 (TTY) Project Address: ____________________________________________________________________________ Legal Description:
__________________________________________________________________________
Parcel Number: _____________________________________________________________________________ Property Owner(s): __________________________________________________________________________ Contractor: ___________________________________
Contractor’s Phone Number: ____________________
Contractor’s Representative: ___________________________________________________________________
SURVEY WAIVER STATEMENT I, _______________________ am hereby responsible for verifying the location of all existing property (Owner or Owner’s Agent) lines prior to beginning construction. The proposed setbacks must comply with all City of Phoenix codes and ordinances. I agree to indemnify and save harmless the City of Phoenix and its elected officials or appointed officials, agents, boards, commissions, employees and representatives from all suits, including attorney’s fees and cost of litigation, actions, loss, damage, expense, cost or claims, of any character or any nature arising out of, or in connection with, the failure to properly locate the existing property lines for the above mentioned project. Dated this _________________ day of __________________________________________20 ____________
____________________________________________ (Authorized Signature)
___________________________________________ (Printed Name and Title)
STATE OF ARIZONA County of Maricopa The foregoing instrument was acknowledged before me this ________________
day of _________ 20 ______
By _______________________________________________________________________________________
My commission expires on: ______________________
Signature: __________________________________
This publication can be made available in alternate formats (Braille, large print, computer diskette, or audiotape) upon request. Contact the Development Services Department at (602) 262-7811 voice or (602) 534-5500 TTY. S:\Pool, Property Survey Waiver.doc WEB/
TRT/DOC/00279 Rev. 3/09
