Mechanical Permit Application - Alliance for Contractors

ALLIANCE FOR CONTRACTORS

Empowering Excellence in Construction

Mechanical Permit Application

Purpose: This application is required for obtaining or renewing a mechanical contractor license in accordance with state and local regulations. All information must be complete and accurate. Incomplete applications will be returned without processing.

Section 1: Application Type

Current License Number (if renewal): Expiration Date:

Section 2: Applicant Information

Personal Information

Full Legal Name: Date of Birth:
Social Security Number: Driver's License Number:

Contact Information

Mailing Address:
City: State: ZIP Code:
Phone Number: Email Address:

Section 3: License Type and Classification

License Classification Requested:

Other (specify):

Section 4: Experience Verification

Minimum 4 years of verifiable experience required. Provide details for all relevant work experience.

Employer/Company Name Position/Title Start Date End Date Type of Work Supervisor Name & Phone
 
 		  
 		  
 		  
 		  
 		  
 
 
 		  
 		  
 		  
 		  
 		  
 
 
 		  
 		  
 		  
 		  
 		  
 
 
 		  
 		  
 		  
 		  
 		  
 
Total Years of Experience:

Section 5: Exam Results and Certifications

Trade Exam Date: Score: Pass/Fail:
Business & Law Exam Date: Score: Pass/Fail:

Professional Certifications:

Specify Other Certifications:

Section 6: Business Information

Business Name:
Business Address:
City: State: ZIP Code:
Federal Tax ID Number: State Tax ID Number:

Business Structure:

Insurance Information:

General Liability Insurance Company:
Policy Number: Coverage Amount: Expiration Date:
Workers' Compensation Insurance Company:
Policy Number: Expiration Date:

Bonding Information:

Surety Bond Company:
Bond Number: Bond Amount: Expiration Date:

Section 7: References and Previous Work

Provide at least three professional references who can verify your work quality and experience.

Reference Name Company Phone Number Email Relationship Years Known
 
 		  
 		  
 		  
 		  
 		  
 
 
 		  
 		  
 		  
 		  
 		  
 
 
 		  
 		  
 		  
 		  
 		  
 

Section 8: Supporting Documentation Checklist

All required documents must be submitted with this application. Check each item as included:

Section 9: Application Fees

Fee Type Amount Check if Applicable
New Application Fee $300.00
Renewal Fee $150.00
Late Renewal Penalty $75.00
Reinstatement Fee $200.00
Additional Classification Fee $50.00 each
Total Fee Amount: Payment Method:
Check Number (if applicable):

Section 10: Applicant Attestation and Signatures

I hereby certify that:

  • All information provided in this application is true, complete, and accurate to the best of my knowledge.
  • I understand that any false statements or misrepresentations may result in denial of the license application or revocation of an issued license.
  • I agree to comply with all applicable federal, state, and local laws, codes, and regulations in the performance of mechanical contracting work.
  • I understand that this license, if issued, is non-transferable and must be renewed according to state requirements.
  • I authorize the licensing authority to verify all information provided and to contact references and employers listed.
Applicant Signature: Date:
Print Name:

Notarization (Required)

State of: _________________ County of: _________________

On this _____ day of _____________, 20____, before me personally appeared _________________________________, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her authorized capacity, and that by his/her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.

Notary Public Signature:
My Commission Expires:
[NOTARY SEAL]

For Office Use Only

Application Received: Received By:
Fee Paid: Receipt Number:
Background Check Completed: Verification Completed:
License Number Issued: Issue Date:
Approved By: Date:

Alliance for Contractors | Mechanical Permit Application | Page 1 of 1

For questions regarding this application, please contact the Licensing Department at (555) 123-4567

Empowering Excellence in Construction