HomeMy Public PortalAboutapplication to city of richmond license.pdf Application To City Of Richmond For License
The undersigned applies for a license indicated by (X) below as covered by City Ordinance.
Electrical Contractor __________________ Heating Contractor ___________________
Today’s Date ________________________ Exam Date __________________________
Name _____________________________________________________________________
Address __________________________________
Home
Phone # ________________________
City ______________________________________
Cell
Phone # ________________________
State___________
Zip ___________
Email ____________________________________
Current Employer __________________________________________________________
Address __________________________________
Business
Phone # ________________________
City ______________________________________
Fax # __________________________
State___________
Zip ___________
Web
Address __________________________________
Currently licensed as _______________________
In ____________________________
For ________ years
Exam was taken at _______________________________________
I will be doing business as ____________________________________________________
Applicant Signature ____________________________________________
Application Fee $10.00
Date Paid ________________
Receipt # _________________
Test Score for Reciprocal License _____________
Date __________________________
Applicant Passed ____________
Applicant Failed ____________
Date _________________________
Board Members Signatures:
_______________________ _______________________
_______________________ _______________________