Form Con - Biennial License Renewal For General Contractor - With Residential Endorsement - Alaska Department Of Community And Economic Development Page 4
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5LICENSE ACTION
The following question must be answered. A “Yes” answer may not automatically result in license denial.
Since the date of your last application:
YES
NO
1. Have you had your license denied, revoked, suspended, surrendered, placed on
probation, or been subject of any restriction, censure, reprimand, or other disciplinary
action in any jurisdiction? ......................................................................................................................
If you answered “Yes” to the above question, please explain dates, locations, and circumstances on a separate piece of paper
and you must send any supporting documents that are applicable (including court records, judgments, charging documents,
etc.). Applications submitted without the appropriate attachments will be considered incomplete and will not be processed.
WARNING: The department may deny, suspend, or revoke the license of a person who has obtained or attempted to obtain
a license to practice as a General Contractor by fraud or deceit. The person may also be subject to criminal charges for perjury
or unsworn falsification. (AS 11.56.210 and AS 11.56.230)
I certify that the information in this application, including the attached insurance and bonding paper, is true and
correct, and that I am the owner of this general contractor business if it is a sole proprietorship or partnership, or that
I am an authorized agent of this business if it is a corporation.
SIGN HERE
Applicant’s Signature
Date:
Please be aware numerous phone calls will delay processing time! You may access the Occupational Licensing
Search program at: , to check on the status of your license expiration
date.
NOTIFICATION OF PROPOSED REGULATION CHANGES
If you would like to receive notice of all proposed Contractor regulation changes, please send a written request
adding your name to the Contractor Interested Parties List to:
REGULATIONS SPECIALIST
Department of Community and Economic Development
Division of Occupational Licensing
P.O. Box 110806
Juneau, Alaska 99811-0806
08-4135 (Rev. 11/02)
Extra Handout Form -G (Internet Version)
(4)
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