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Development Group
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ADDENDUM TO BUILDING PERMIT NUMBER(S) d O 0 CJ
7618 AA �r
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:
► �ti ARS 32-1121.A.5, The applicant owns the property and shall occupytheproperty, and does not
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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
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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 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 Signatufof applicant Date
DSCC01.0
City of Glendale * 5S50 "'es: Glendale Avenue * Glendale, Arizona S5301-2599 * (602) 930-2S00