HomeMy WebLinkAbout53033 (4) RECEIVED
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OCT 4 1 2009
Community.
DEVELOPMENT GROUP
GUNDevelopment Group
OWNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) S.-ICS3R
ADDRESS 6.1I N. �3 '.4D 34
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The undersigned applicant asserts that she or he is exempt from the original contractor licensing requirement
of Arizona Revised Statues Chapter 10, Title 32 on thc.basis of:
1- ARS 32-1121.A.5. The applicant owns the property and shall occupy the property, and does not intend
the property to be for sale or rent, and shall have the work performed by the applicant alone, or by the
applicant with employees of the applicant, and/or performed by duly licensed contractor(s) all of whom
are identified below or on the attached.
— ARS 32-1121.A.6. The applicant owns the property and shall have the work performed only by duly
licensed contractor(s) all of whom are identified below or on the attached.
Contractor/Company Name License Number Classification
— ARS 32-1121.A.7. The applicant is a registered architect or engineer, or employee of registered
architect or engineer engaged in professional practice, not as a contractor.
The undersigned swears and affirms that the information herein is true and accurate, and acknowledges that
the filing of an application containing false or incorrect information with the intent to avoid the licensing or
tax requirements of the State of Arizona is `unswoin falsification," a criminal misdemeanor.
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Printed Name of Owner Signature of Owner Date
City of Glendale T 5850 West Glendale Avenue *Glendale, Arizona 85301-2599 * (602) 930-2800
CITY OF GLENDALE
�eCommunity Development Group BUILDING PERMIT INSPECTOR COPY
,,q, 5850 West Glendale Avenue
GLEN1f/y1 E Glendale,Arizona 85301-2599
Yi Office: (623)930-2800 Inspections: (623)915-3263 Permit No. 53033 Inspection Area: MH Issue Date: 10/01/2009
`, ` PROJECT:INFORMATION ? 3444,1„ ProjedNo. o Ft. Valuation
Property Location(Verify City and Zip Code mailing address with Postal Service) ` ',t 1 f i. - '"#' x4,
Permit Type
5484 N 43RD AVE SPC 35 yr '£ , A r 4741rDT yl =:fxvfi ta BS-ELEC
Location Parcel Subdivision 'per ` > ° `' = , " r "�' Lot#
, � y...fi c � Issued By Statistical Code STD#
xY 1 ,k_ �e : W714 :l [
fix c • 3 COLORESL 700
-OWNER INFORMATION =Sewer Bray Gas Water Meter
Name .:-.-,1;2:1 ` ' Telephone" - .FF Cer Req
SAMUEL HAIRSTON (623)205-5333 } "'
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Address `
5484 N.43RD AVE GLENDALE AZ 85301 ,- ffi: "v �`P".€ ,l e,
y s; , - . -a; ,� . Construction Type Occupancy Group
PRIME CONTRACTOR"INFORMATION
Name 5 r "+ il� �,;,�, -` Telepho, ne `""
OWNER-BUILDER k€' �, aak.s k`<
4 L ;�Y @ 6 V {3 i :,
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Address .. > rr�a- '. ,� " '�;
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Contractor License No. License Type Salestax License No s.-3< '
Description of Work/Special Conditions=:i"" :44; ,c' "a"
HAIRSTON RESIDENCE REPLACE A 200 AMP ELECTRICAL PANEL TO 100 AMP PANELCI - ' � ' L
ELECTRICAL PERMIT: ,- >r r �;,� "-' ,4. Inspebto •r� /b (yam
..,...r..: 1'lIAl1,..c." �,';x.Date`of Final �C1 `0
"/i i Certificate of Occupancy Number
METERE C AR' ``ANCES INFO MATION
J,
Electrical�7 iR I k 1" Date
Gas Date
I hereby certify that I am the owner or duly authorized owner's agent,that I have read this application and that all information is correct. I further certify that I have read, understand and will comply with
all the provisions outli d hereon. Iall�g !ce t t the plotpla ubmitted is a complete and accurate plan showingo any and all existing proposed structures on the subject property.
Signature a -72 7 'I-'! 4' _ iLA.id��lf�� Date 0"/'d 1 ho
Provisions: The applicant is advised that issuance of this permit will not relieve responsibility of the owner or owner's agents to comply with the provisions of all laws and ordinances, including federal,
state and local jurisdictions,which regulate construction and performance of construction,or with any private deed restrictions. This permit becomes null and void if the construction work authorized is
not begun within 180 days from the date of issue or if at any time prior to final inspection and approval the work is suspended or abandoned for a period of 180 days.