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GI Development Group
OWNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) 7 7 2- 1 0
ADDRESS 7 7 60 i,t,, . r 1"-C_ Alia-
-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 the basis of:
)4 ARS 32-1121.A.5. The applicant owns the propertyand shall occupytheproperty, and does not intend
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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 info..•: '. with the intent to avoid the licensing or
tax uirements of the State of Arizona is "unsworn f..-' ication," - criminal .•' • eanor.
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Printed Name of Owner Signature of Owner Date
City of Glendale * 5850 West Glendale Avenue.*Glendale, Arizona 85301-2599 * (602) 930-2800