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OWNER/BUILDERADDENDUM TO BUILDING PERMIT NUMBER(S) ,...,ok 1 '-i----
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The undersigned applicant asserts that she or he is exempt from the original:contactor licensing requirement
of Arizona Revised Statues Chapter 10,Title 32 on the basis of:
k-ARS.32-1121.A.5._The_applicant o_wns_the_property-and shall_occupythe=proper y,_and_doe,s_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 32-112T.A.6. The applicant owns the property and shall have the work performed only by duly
licensed contractor(s) all of whom are identified below or on the attached.
Contractor/Company Name License Number Classification
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— ARS 32-1121.A.7. The applicant'is 'a 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 the licensing or
tax requirements of the State of Arizona is "unswornfalsification," a criminal misdemeanor.
09-13-09
IPnrited--Name of Owner (Signature of Owner �� ®ate ,
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City of Glendale * 5850 West Glendale Avenue *Glendale,Arizona 85301-2599 * (602) 930-2800