HomeMy WebLinkAbout029795 E �ND9 Mayor
w�i®!`., �� GEORGE R.FENNER
44 v .� CITY OF GLENDALE �.�HEAT
#�/ �, BRUCE E.HEATWOLE
Coaxilmen
5850 West Glendale Avenue RICHARD BELLAH
JOE A FALBO
1); t; Glendale,Arizona 85301 ROBERT I. HUFFN.AN
Z0 IAN HUGH
A — (602)435.4000
OUENTIN V.TOLBY
' DECLARATIONS. Check the appropriate box, complete the required
information in the selected declaration, sign and date.
CONTRACTOR
LICENSED. I hereby affirm that the applicant is currently
licensed under the provisions of ARS Title 32 , Sec. 32-1101
through Sec. 32-1198 .
Lib. No. State Tax Lic. No.
EXEMPTION. I hereby affirm that the applicant is exempt from
licensing for the following reason.
GOVERNMENTAL. Agency of the U. S. Government, State of
Arizona, County, Municipality or Political Subdivision.
(ARS Sec. 32-1121.A. 1) .
v• OWNER/BUILDER. Improving owner(s) property themselves or
jointly with licensed contractors and said improvements are
not for sale or rent (ARS Sec. 32-1121.A. 5) .
RESIDENTIAL OWNER. Owner(s) of residential property using
only licensed contractors (ARS Sec. 32-1121.A. 6) .
ARCHITECT/ENGINEER. Engaging in professional .practice as
defined in ARS Title 32 , Chapter 1, and not engaging in
contracting (ARS Sec. 32-1121.A. 7) .
OTHER. -7-0F Q 4P 4-7 60
a > 3-1,lt;S( ( — 01-F 1 Z
(6'7Vitu± v114Avytv,I,)
Signature Date / = go0 9�
D FOR
DEPARTMENT USE ONLY
Permit(s) 0 9 1/ (.
Single statement may be used for consecutively numbered permits.