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2. Plumbing Contractor's License Application

   LICENSE EXPIRES APRIL 30th EACH YEAR

4. Date*
   Date
5. Name*
6. Company Name*
8. Address*
9. City, State*
10. Zip Code*
12. Email Address*
13. Business Phone*
15. Hereby apply for a license to engage in the business of:*
17. Upload | 055 License*
18. Upload | 058 License*
20. Upload | Letter of Intent*

    Must be notarized, with official company letterhead/seal

21. Electronic Signature Authorized*

    1. Yes
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

* indicates a required field