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Home My WebLink About192120 CITY OF GLENDALE .440; PLANNING&DEVELOPMENT SERVICES 5850 W.GLENDALE AVE.,2ND FLOOR RECEIVED GLENDALE,AZ85301 OWNER BUILDER ADDENDUF GlendateT 623.930.2800 DEC 13 2019 ARIZONA www.GlendaleAZ.com RESIDENTIAL PROJECTS ONL DATE:/ / SFR'�rf.Fq COG PERMIT NUMBER: g 2\ i PROJECT NAME: PROJECT ADDRESS: 1Ay [�,� D�� C31 'L ✓- - a5©6 The undersigned applicant asserts that she or he is exempt from the original contractor licensing requirement of Arizona Revised Statutes Title 32,Chapter 10, on the baasis f: (V 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: AZ ROC NUMBER: LICENSE CLASSIFICATION: ❑ ARS 32-1121.A.7 The applicant is 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 licensing or tax requirements of the State of Arizona is"unsworn falsification",a criminal misdemeanor. PRINTED NAME OF THE OWNER: SIGNATURE OF THE OWNER: DATE: