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Get Michigan Builder Qualifying Officer

0245, Lansing, MI 48909 517-241-9288 www.michigan.gov/builders Date Approved: License Number QUALIFYING OFFICER CHANGE APPLICATION AUTHORITY: 1980 PA 299, MCL 338.3434(A), AND 42 USC 654 PENALTY: FAILURE TO PROVIDE THIS INFORMATION MAY RESULT IN DENIAL OF THE APPLICATION AND/OR DISCIPLINARY ACTION. Name of Company Permanent ID # Business Address (NO PO BOX) City State Zip Code Mailing Address (if different) City State Zip Code Telephone Number E-mail Address NEW QUALIFYING OFFICER.

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