Form 08-4161 - Residential Contractor Endorsement Application
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STATE OF ALASKA
FOR OFFICE USE ONLY
DEPARTMENT OF COMMUNITY AND
ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
P.O. BOX 110806
JUNEAU, AK 99811-0806
Telephone: (907) 465-2546 or 465-3035
E-mail: license@dced.state.ak.us
RESIDENTIAL CONTRACTOR
ENDORSEMENT APPLICATION
PLEASE READ INSTRUCTIONS BEFORE COMPLETING APPLICATION
$50 Nonrefundable Application Fee
$75 Examination Fee
$100 Endorsement Fee
Indicate Exam Location:
Anchorage
Fairbanks
Juneau
Name:
Last
First
M.I.
SUFF
Social Security Number:
Sex:
Male
Female
(Required by AS 08.01.060)
Date of Birth:
(Month/Day/Year
Mailing Address:
Street or P.O. Box Number
City
State
ZIP Code
Daytime Telephone Number:
A residential endorsement must be assigned to a properly licensed general contractor. In order to have your
endorsement assigned to a general contractor, you must meet the criteria of one of the following:
•
Sole Proprietor - must be his/her own endorsement holder
•
Partnership - one of the partners must be the endorsement holder
•
Officer or employee - endorsee must be an officer or employee of the corporation
Company Name:
License No.:
Capacity in which you are associated with this company:
Sole Proprietor
Partner
Officer or employee of corporation
OR
Do not have a construction contractor license at this time.
Satisfactory completion of the Alaska craftsman home program training or its equivalent within two years before the date
of application is required for endorsement. Indicate below which course(s) you have taken and the date(s) of completion.
Please attach copies of the certificate(s) or make arrangements for the official transcripts from the school
attended to be sent directly to this division to verify completion of the course.
Name of Course
Sponsor of Course
Date of Completion
08-4161 (Rev. 2/00)
CONTINUED ON REVERSE SIDE
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