HomeMy WebLinkAbout3/22/2002 9100 ITY OF IOWA CITY, IOWA
APPLICA TIOIV FOR Alii £L£¢7'RI¢iA~'$ LICENSE
This application must be filled out completely and in detail
and shall be on file with the Building Official.
CITY OF IO.WA CIT~
Type of license for which you are applying:
NAME L,.,/,,, ,,-,,
J~'Journeyman
[] Master's
[] Restricted
[] Maintenance
RESIDENCE ADDRESS
TELEPHONE NUMBER _/~lf--'/
PRESENT EMPLOYER ~C.~..
ADDRESS OF EMPLOYER
AGE ,.~t.J - DATE OF BIRTH
STATE ~-I~ " Z~P ~2-31 ?-
SOCIAL SECURITY NO. /--/::~-O~;~-O'3 L/~__
BIRTHPLACE /qc¥~/~ ~, ~Ly
City
State
Have you ever had an electrical license revoked?
And if so, give reasons:
By whom?
Have you previously been examined for an Electrical License by this Board?
If so, state type and results of examination:
Was it approved?
Have you previous made an application for a City of Iowa City Electrical License?
(over)
CIVIC CENTER · 410 EAST WASHINGTON STREET · IOWA CITY, IOWA 52240 · (319) 356-5000
ELECTRICIAN'S LICENSE APPLICATION - CITY OF IOWA CITY
ELECTRICAL EMPLOYMENT RECORDS
(Give previous and present employers and complete address.)
Page 2
EMPLOYER
COMPLETE ADDRESS
DATES EMPLOYED: From OcJfo~P__,~'
Type of Electrical Work
EMPLOYER
DATES EMPLOYED: From
Type of Electrical Work
EMPLOYER
DATES EMPLOYED: From
Type of Electrical Work
COMPLETE ADDRESS
to
EMPLOYER
DATES EMPLOYED: From
Type of Electrical Work
COMPLETE ADDRESS
to
If this application is approved by the City, you will be notified as to when you will take your examination.
The foregoing statements are true and correct to the best of my knowledge and belief.
Signature of Applicant
hisblg~electlic.app
!
Date