Form Con - Biennial License Renewal For General Contractor - With Residential Endorsement - Alaska Department Of Community And Economic Development Page 2
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5LICENSE RENEWAL FEES
CHECK APPROPRIATE LICENSE BOX
License $200.00
Prorated License $100.00 -
Prorated fee applies only to initial licenses (Numbers greater than 28289), issued within the
past 12 months.
Name of Business:
Corrected Mailing Address (complete only if address is different than the address label shown on page 1) :
Street or P.O. Box
City
State
ZIP Code
Daytime Telephone Number:
License Number:
TYPE OF BUSINESS
Licenses are nontransferable and any change of ownership/company reorganization requires a new contractor application and
a new business license. Please note: Husband and wife businesses are recognized as a partnership.
Sole Proprietorship
Partnership
Corporation
Limited Liability Company
Name of Owner(s)/
Date
Complete Owner Mailing Address
Social Security #
Partners/Officers
of Birth
(if different than label on front)
1.
2.
(If more space is needed, attach a separate sheet.)
ELECTRICAL AND MECHANICAL ADMINISTRATORS
If this business performs electrical or communications contractor work, list the electrical administrator(s) supervising that
work:
License #
EA Name
License #
EA Name
If this business performs mechanical or plumbing work, list the mechanical administrator(s) supervising that work:
License #
MA Name
License #
MA Name
IF THE ADMINISTRATOR(S) ASSIGNED TO THIS GENERAL CONTRACTOR LICENSE CHANGED DURING THE LICENSE
PERIOD, YOU WILL NEED TO COMPLETE A CHANGE OF AFFILIATION FORM. THE FORM IS AVAILABLE AT THE DIVISION
WEBSITE AT:
RESIDENTIAL ENDORSEMENT
Will this business build or remodel residential structures of one-to-four units?
Yes
No
If “No,” the general contractor license will be issued as General Contractor - Excludes Residential.
If the business will be performing residential construction, at least one Residential Endorsement holder must be assigned to
the business.
(1)
(2)
Endorsement #
Name of Endorsee
Endorsement #
Name of Endorsee
If applicable, the Residential Endorsement holder’s renewal application must be submitted with this contractor
application.
According to 12 AAC 21.690, a Residential Endorsement may be assigned to no more than two general contractors.
Failure to submit the residential endorsement renewal application with this completed general contractor renewal
application, and providing the Residential Endorsement holder has not already renewed separately, will result in the
general contractor renewal being processed as a General Contractor – Excludes Residential.
08-4135 (Rev. 11/02)
CONTINUED ON NEXT PAGE
Extra Handout Form -G (Internet Version)
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