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GLEN DE Development Group
ADDENDUM TO BUILDING PERMIT NUMBER(S)
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 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 32-1121.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
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 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 "unsworn falsification, " a criminal misdemeanor.
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Printed name of Applicant Signature of Applicant Date Signed
City of Glendale•5850 West Glendale Avenue•Glendale,Arizona•85301-2599•(602)435-4169