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11111�T .PN,TT4fl Development Group
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ADDENDUM TO BUILDING PERMIT NUMBER(S) .Da_r rl. C ek_ c
The undersigned applicant asserts that she or he is exempt from the contractor licensing requirement
of Arizona Revised Statutes Chapter 10, Title 32 on the basis of:
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- ---&—/—-ARS-32-112=1:A-S --The-applicant-o4 ns-the-property and-shah-o-ccupy-the property, and sloes
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.
�l. 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
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ARS 32-1121.A.7. The applicant is a registered architect or engineer, or employee of a
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 "unsworn falsification," a criminal
misdemeanor.
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Printed name of Applicant Signature of Applicant Dat
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City of Glendale'5850 W.Glendale Avenue*Glendale,Arizona 85301-2599*(623)930-2800