Contractor Licensing Section Form - State Of Alaska (Page 4 of 8) in pdf

Contractor Licensing Section Form - State Of Alaska Page 4

LICENSE ACTION

The following question MUST be answered. A “Yes” answer does not automatically result in license denial.

Since the date of your last application for a general contractor license have you or an owner, partner,

corporate officer, or managing partner had a professional license denied, revoked, suspended, or otherwise

restricted, conditioned, or limited or have you surrendered a professional license, been fined, placed on probation,

reprimanded, disciplined, or entered into a settlement with a licensing authority in connection with a professional

license you hold in any jurisdiction including Alaska and including that of any military authorities or is any such

action pending?

Yes

If you answered “Yes” to the above question, provide a detailed explanation in writing, including dates, locations and

circumstances on a separate piece of paper. You must send any supporting documents that are applicable (including court

records, judgments, charging documents, etc.). Renewal 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 unsworn falsification. (AS

11.56.210)

I certify that the information in this application, including the attached insurance and bonding documents, is true and correct,

and that I am the owner of this general contractor license if it is a sole proprietorship or partnership, or that I am an

authorized agent or managing partner of this business if it is a corporation or LLC.

SIGN HERE

Applicant’s Signature

Print Name

Date:

FOR QUESTIONS REGARDING YOUR RENEWAL:

If the first word of your business name begins with A – F contact: (907) 465-8444

If the first word of your business name begins with G – M contact: (907) 465-5470

If the first word of your business name begins with N – Z contact: (907) 465-5372

Website:

08-4135

Rev. 12/17/14

Application page 4 of 4

Contractor Licensing Section Form - State Of Alaska Page 4