Contractor Licensing Section Form - State Of Alaska Page 2
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81)
TYPE OF BUSINESS OWNERSHIP
Licenses are not transferable. If there has been a change in ownership or business name since your last renewal, you cannot
use this form. Call the appropriate phone number listed on page 4 of this application to obtain the correct form.
Sole Proprietorship (one person)
Partnership (two or more persons)
Corporation
LLC
Social Security #
Date of Birth
Name and Address of Owner(s), Partners, Corporate Officers,
or Managing Partners
(Required for sole proprietorship and partnerships)
1.
2.
3.
(If more space is needed, attach a separate sheet.)
2)
RESIDENTIAL ENDORSEMENT
Will this business build or remodel privately-owned residential structures of one to four units?
Yes
No
(If you answer “no” or do not list a residential endorsement holder, the license will be renewed as General Contractor –
without Residential Contractor Endorsement.)
If the business will be building or remodeling residential structures of one to four units, a residential endorsement holder must be
assigned to the business. A residential endorsement holder may be assigned to no more than two general contractors.
Name of Endorsement Holder
Endorsement Number
Name of Endorsement Holder
Endorsement Number
If you are the residential endorsement holder assigned to your own business as a general contractor, please submit your
residential endorsement renewal together with this general contractor renewal to avoid delays in processing.
3)
ELECTRICAL AND/OR MECHANICAL ADMINISTRATOR ASSIGNMENT
If your business performs electrical or communications contractor work, list the electrical administrator’s name and license number
assigned. Attach separate sheet if necessary.
Name of Electrical Administrator
License Number
Name of Electrical Administrator
License Number
If your business performs mechanical or plumbing work, list the mechanical administrator’s name and license number assigned.
Name of Mechanical Administrator
License Number
Name of Mechanical Administrator
License Number
If the administrator assigned to your business has changed during the licensing period, a completed Change of Employer/Affiliation
Form (#08-4102) must be submitted with your general contractor renewal application. This form is available on our website under
Miscellaneous Forms.
08-4135
Rev. 12/17/14
Application page 2 of 4
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