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ADDENDUM TO BUILDING PERMIT NUMBER(S)
, 7i" DJL. •
The undersigned applicant asserts that she or he is•exempt from the contractor licensing requirement
of Arizona Revised Statutes Chapter i0, Title 32 on the basis of:
--- —X--=AR-S-32-11-2=1-A:5. The-applic nt-owns--tf-re-pr-o-pe.rty-and-s-ha;II-occap-y=t he 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 ciul,
licensed contractor(s) all of whom are identified below or on the attafhed.
ARS 32-1121.A.6. The applicant owns the property and shall have the Work performed only
by duly licensed contractor(s) a!! of whom are identified below or on the attached.
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Contractor/Company Name License Number. Classification
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ARS 32-i 121.A.7. The applibant is a registered architect or en=.neer, or employee of a
registered architect or engineer engaged in professional practice, nc: as a contractor.
The undersigned swears and affirms that the .information herein is :-ue and accurate, an:;
ackno'...e"ides that the filing of an app lcatioln containing false or incorrect . .:oormaion with the inten:
to avoid the licensing or tax rec Jire eras of StateArizonav - `
m theof is uns.._ ., talsl�;ca:ion, a crin-:.n=:
misdemeanor.
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To L outc_ ct -lv,wr, ll , l�. 0-A- :. . 2-22-dS
• Printed name of Applicant Signature c'f Applicant Date
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