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HomeMy WebLinkAbout120797 q7L) y O 'NE UILDER ADDENDUM OWNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) ADDRESS "?-t.e©S N ((fi D Q (s-(e do cf 4(_ VA? Fi3-3 O Y 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: ^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 orrent, 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 licensed contractor(s) all of whom are identified below orlon the attached. work shall have the performed only by duly Contractor/Company Name License Number Classificatti®n — 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"unworn falsification,"a criminal misdemeanor. PI40L (-iv`jnj (+ �� rf• 21 P Printed Name of Owner Sig nae of O r Date City of Glendale Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599• Phone(623)930-2800 www.glendaleaz.com