Form 08-4033 - Mechanical Administrator'S License Application
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1
2MEC
STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND
ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
P.O. BOX 110806
JUNEAU, AK 99811-0806
Telephone: (907) 465-2589
E-mail: license@dced.state.ak.us
MECHANICAL ADMINISTRATOR’S LICENSE APPLICATION
THIS APPLICATION MUST BE COMPLETED IN FULL. If any section does not apply, please write N/A in the space provided. TYPE
OR PRINT IN INK ALL INFORMATION. A check or money order MUST accompany this application.
Nonrefundable Application Fee:
$ 50.00
Exam Fee:
$ 75.00 (per category)
License Fee:
$ 275.00
I HEREBY MAKE APPLICATION for licensure as a Mechanical Administrator in the State of Alaska by:
Examination
Credentials
Reinstatement of Alaska License No.
Adding license category to Alaska License No.
In the category of :
i Heating, Cooling and Process Piping (HCPP)
i Unlimited Refrigeration (UR)
i Unlimited HVAC/Sheetmetal (UHVCS)
i Unlimited Commercial and Industrial Plumbing (UCIP
i Residential HVAC (RHVC)
i Residential Plumbing and Hydronic Heating (RPHH)
i Mechanical Systems Temperature Control (CNTL)
EXAMINATION SITE:
ANCHORAGE
FAIRBANKS
JUNEAU
Name:
Social Security Number:
Address:
Street or P.O. Box
City
State
Zip Code
Work Telephone:
Home Telephone:
Place of Birth:
Date of Birth:
Height:
Weight:
Hair Color:
Eye Color:
Have you ever been known by any other name?
No
Yes
(If name change was by court order, enclose a certified copy of such order.)
Mechanical contracting business in which you have previously engaged:
Do you hold a certificate of fitness issued by the Alaska Department of Labor?
Yes
No
Category:
Certificate Number:
First Issued:
Expiration Date:
TRAINING OR EDUCATION
If you are substituting education for some of the experience requirements and are a graduate of an accredited college, university,
or trade school, transcripts MUST be sent directly to the division from the college, university, or trade school.
Description of Education
From
To
Name of School
and/or Training
Yr. and Mo.
Yr. and Mo.
08-4033 (Rev. 8/00)
CONTINUED ON REVERSE SIDE
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