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�''`u k,{ OWNERJBUILDER ADDENDUM
O,WNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) I °t/7 7 /
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Theuridersigned applicant asserts that she or he is exempt from the original contractor licensing requirement of
z Ariona Revised Statues Chapter 10, Title 32 on the basis of:
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= ARS 32-1121.A.5. The applicant owns the property and shall occupy the property, and does not intend
r,`'t•. 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
''f'r''e!,:.' ' are'identified below or on the attached.
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-,'. ' ,-:: ARS 32-1121.A.6. The applicant owns the property and shall have the work performed only by duly
:f .,/ licensed contractor(s) all of whom are identified below or on the attached.
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=+ -'Contractor/Company Name License Number Classification
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'`l!... . ARS 32-1121.A.7. The applicant is a registered architect or engineer, or employee of registered architect
t ` n or engineer engaged in professional practice, not as a contractor.
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The::undersigned swears and affirms that the information herein is true and accurate, and acknowledges that the
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.,,: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.
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Pt inted Name of Owner, Signature o Owner'; �Date,� .
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,. , + t , City of Glendale
.;,.ti ,;,, ;;';.,,.;Development Services•5850 West Glendale Avenue•Glendale,Arizona 85301-2599• Phone(623)930-
2800
;v.;, www.glendaleaz.corn
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