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7I Development Group
OWNER/BUILDER ADDENDUM TO BUILDING PERMIT NUMBER(S) lV.10 1
ADDRESS 75 Av e i C_-= Io f\dLe i A? E31
:The undersigned applicant asserts that she or he is exempt from the original contractor licensing requirement
of Arizona Revised Statues Chapter 10, Title 32 on the basis of:
�t, ARS 32-1121.A.5. The applicant owns the property and shall occupy the propertyand 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)r all of whom
are identified below or on the attached.
— ARS 32-1121.A.6. The applicant ownsthe°..popetty 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
31= ,
—' `ARS 32-1121.A.7. The applicant-is' a registered architect or engineer, or employee of registered •
architect or engineer engaged in professional: 'ractice, not as a contractor.
i.i... -1`.
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 "unworn falsification," a criminal misdemeanor.
1\aI.r . �'b U i1ZZc� V, 111 r3 r�/62o q
PrintedName o f wner " S' a 'e o ?.�- D
City of Glendale * 5850 West Glendale Avenue.*.Glendale,Arizona 85301-2599 * (602)930-2800