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GIFNTI1 Development Group
ADDENDUM TO BUILDING PERMIT NUMBER(S) /ZZZ) t -/
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The undersigned applicant asserts that she or he is exempt from the contractor licensing requirement
of Arizona Revised Statutes Chapter 10, Title 32 on the basis of:
ARS 32-1121.A.5. The applicant owns the property and shall occupy the property, and does
not intend the property_ to be for saJ-e_o; rent,--and--shall have-.t'he 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 32-1121.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 a
registered architect or engineer engaged in professional practice, not as a contractor.
The undersigned swears and aIrms that the Information herein is true and accurate, and
ac:kn7...edces that the filing of an application c0n:a nine false or incorrect information ‘.;ith the intent
to a`.c the licensin-..1 or tax rec'u:.ements of th Stat., of Ari_one is "uns'.'.00m falsification," a criminal
misdemeanor.
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rinteci name of Applicant Smature of Applicant Date
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