HomeMy WebLinkAbout121328 CITY OF GLENDALE q /PLANNING&DEVELOPMENT SERVICES t 1
1 5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE,AZ 85301
1 eitE a e. 623.930.2800 OWNER/BUILDER ADDENDUM
ARIZONA www.GlendaleAZ.com RESIDENTIAL PROJECTS ONL`
DATE:
COG PERMIT NUMBER:fp 00 ? cle) /7
PROJECT N E: PROJECT ADDRESS:
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The undersigned applicant asserts that she or he is exempt from the.original contractor licensing requirement of Aril;Ona Revised Statutes Title 32,Chapter 10,
on the basis of::.
ARS 32-1121.A.5The 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 applicantand/or performed by duly licensed
contractor(s)all of whom are identified below or on the attached.
-—= ---- _O- ARS 321121.A.6 The applicant owns the property and shall have the work performed only by duly licensed-contractcr(s)all of-whom are identified—
below or on the attached:
CONTRACTOR/COMPANY NAME : AZ ROC NUMBER: LICENSE CLASSIFICATION:
O 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
1 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 0 ER: . ,r s.. l •,i i R. DATE -