HomeMy WebLinkAbout123955 CITY OF:GLENDALE
: c...,:, i PLANNING&DEVELOPMENT SERVICES . .
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE;AZ 85301
: ie l 623:930.2800 OWNER/BUILDER ADDENDUM
A R:I z o i..A www:GlendaleAZ.com RESIDENTIAL PROJECTS ONLY
DATE: ... COG PERMIT NUMBER: .
- 1 r-70 1 3 l 55
PROJECT NAME: . PROJECT ADDRESS: .
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d�°'11�.. � G�a�-:2 !I/(/e�Z ,C,4 3 y /j% V-4 LiN I'I v . 1 .'qc�ai.,
The undersigned applicant asserts that she or heis exempt from the original contractor licensing requirement of,Arizona-Revised Statutes Title 32.,Chapter10,
on the basis of:
a 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'321121.A:G The-appiicant owns-the property a-id shalt have the-workperforn-red-only-by:duly-licensed contractor(s)-ail o`twham 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 ÂME OF THE OWNER: SIGNATURE• OF THE OWNER: ~DATE:
2 . ;Z /? 2020