HomeMy WebLinkAbout122575 CITY OF GLENDALE
PLANNING&DEVELOPMENT SERVICES
5850 W.GLENDALE AVE.,2ND FLOOR
GLENDALE;AZ 85301 .
Re ( ,6gi 623.p30.28Q0
OWNER/BUILDER ADDENDUR
k'R I z o N A www.Glenda►eAZ.com RESIDENTIAL PROJECTS ONL'
DATE: C3 � ..�� 2. COG PERMIT NUMBER:: 12273
PROJECT NAME: PROJECT ADDRESS:
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The undersigned-applicant asserts that she or he is exempt from the original contractor licensing requirement of Arizona Revised Statutes Title 32,Chapter 10,
onttiebassof:.
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.
D 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 are identified.
- -- -- -below°o�'crrtfie.attached: ------
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CONTRACTOR/COMPANY NAME :AZ ROC NUMBER LICENSE CLASSIFICATION:
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D ARS 32=1121.A.7 The applicant is registered architect or engineer,or employ ee 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 en application containing false or
! incorrect information with the intent to avoid licensing ortax requirements of the State of Arizona:is"unsworn falsification";a criminal misdemeanor.
PRINTED:NAME OF THE OWNER: SIGNATU. OF THE 0 ER: : DATE:' •