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Get NYC Buildings LIC38 2013

LIC38 ELECTRICAL LICENSE APPLICATION Application must be typewritten. 2 License Type 1 Application Type Original Renewal Reissue Change 3 License Number Master Special 4 Applicant Information Required for all applications. Indicates optional* First Name Middle Initial Last Name Home Address Home Telephone City State Zip Mobile Telephone Social Security No* Date of Birth m/d/y E-Mail 5 Responsible Representative Note There can be ONLY ONE Responsible Representative Are you the Responsible Representative for the business YES NO If so please print their names for additional space attach a second sheet Do you authorize this person s to file electrical applications under the business name Initial here 6 Business Information Business Name Firm No* Office Address Office Telephone Office Fax 7 License Use Choose One MASTER Individual/Sole-Proprietor On Behalf of a Corporation On Behalf of a Partnership On Behalf of a Trade 8 Partner or Officer Information Name Address Title s 9 Convictions If you answer Yes to the question below you must complete and attach form LIC34. Yes No Have you ever been convicted of a crime for renewals convicted since your last renewal 10 Applicant Statements and Signatures As a condition of being granted a license from the Department of Buildings I hereby agree to comply with all Administrative Code Provisions and Department Rules Regulations and Directives regarding how licensees conduct their specific trades. I affirm compliance with Section 27-3013 a and the definition of responsible representative found in Section 27-3004 when the designated responsible representative of the business is submitting this renewal application* Falsification of any statement is a misdemeanor under section 28-211. 1 28-201. 2. 1. 2 and 28-203. 1. 1 of the Administrative Code and is punishable by a fine or imprisonment or both. Bribery is a crime A person who gives or offers a bribe to any employee of the City of New York or an employee who takes or solicits a bride is guilty of a felony punishable by imprisonment a fine or both. Name print Signature Date Electrician s Seal Notarization State of New York County of Notary Seal Sworn to or affirmed under penalty of perjury Day of Notary Signature Internal Use Only Clerk s Signature Fee Paid Year 10/13. Indicates optional* First Name Middle Initial Last Name Home Address Home Telephone City State Zip Mobile Telephone Social Security No* Date of Birth m/d/y E-Mail 5 Responsible Representative Note There can be ONLY ONE Responsible Representative Are you the Responsible Representative for the business YES NO If so please print their names for additional space attach a second sheet Do you authorize this person s to file electrical applications under the business name Initial here 6 Business Information Business Name Firm No* Office Address Office Telephone Office Fax 7 License Use Choose One MASTER Individual/Sole-Proprietor On Behalf of a Corporation On Behalf of a Partnership On Behalf of a Trade 8 Partner or Officer Information Name Address Title s 9 Convictions If you answer Yes to the question below you must complete and attach form LIC34. Yes No Have you ever been convicted of a crime for renewals convicted since your last renewal 10 Applicant Statements and Signatures As a condition of being granted a license from the Department of Buildings I hereby agree to comply with all Administrative Code Provisions and Department Rules Regulations and Directives regarding how licensees conduct their specific trades. .

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