HomeMy WebLinkAbout4/4/2002Oxley, Robert ITY OF IOWA CITY, IOWA ,_
APPLICATION FOR AN ELECTRICIAN'S LICENSE
This application must be filled out completely and in detail
and shall be on file with the Building Official.
CITY OF IOWA CITY
Type of license for which you are applying: [] Journeyman
M Master's
[] Restricted
TELEPHONE NUMBERC.~/~-' 6 7~-JJ Og SOC,AU SECU~,*Y NO. g¢O-~ 7- ¢~,3
AGE C~ DATE OF BIRTH & ~')~X - ~ ~ BIRTHPLACE!el'Ih*_~ ~~?:
City State
Have you ever had an electrical license revoked?
And if so, give reasons:
'~, (--') By whom?
Haveyou previously been examined foran Electrical License by this Board?~_ i%[ q~
If so, state type and results of examination' ~-~ \/~ ,~'-' ~-'~ ~..-~,~.~..,~,?('N ] ~.~:: ._
Have you previous made an application for a City of Iowa City Electrical License?
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CIVIC CENTER · 410 EAST WASHINGTON STREET · IOWA CITY, IOWA 52240 · (319) 356-5000
3TRICIAN'S LICENSE APPLICATION - CITY OF IOWA CITY Page 2
LOYER
'ES EMPLOYED:
ELECTRICAL EMPLOYMENT RECORDS
(Give previous and present employers and complete address.)-
4 .---, q.d::j
~. of Electrical Work
COMPLETE ADDRESS
'LOYER
-ES EMPLOYED' From
~ of Electrical Work
COMPLETE ADDRESS
to
LOYER
'ES EMPLOYED: From
~ of Electrical Work
cOMpLETE ADDRESS
to
'LOYER
'ES EMPLOYED: From
~ of Electrical Work
COMPLETE ADDRESS
to
this application is approved by the City, you will be notified as to when you will take your examination.
foregoing states_merits ar,p/t'~Lnd correct to the best of my knowledge and belief.
~ature of Applicant ~ Date