Get Ny Lic2 2008

LIC2 License Application Application must be typewritten. 1 Application Type Original 2 License Number Renewal Reissue Change 3 License Type Elevator Inspector Engineer Stationary Hoisting Machine Operator Master Plumber Oil Burning Equipment Installer Rigger Master Special Tower Sign Hanger Site Safety Manager Coordinator Welder Master Fire Suppression Piping Contractor Class Portable 4 Applicant Information Required for all applications. Indicates optional* First Name Middle Initial Last Name Home Address Home Telephone Zip Mobile Telephone Date of Birth m/d/y City State Social Security No* E-Mail Driver License No 5 Business Information Indicates optional 6 License Use Business Name Office Telephone Office Address Office Fax Choose One Individual/Sole-Proprietor On Behalf of a Corporation Shop Address On Behalf of a Partnership Shop Telephone 7 Partner or Officer Information Name Address Lic No Control Phone Title s 8 Affiliation Complete this section only if you have additional affiliations for this license type other than the one listed on this application* 9 Convictions and Fines If you answer Yes to either of these questions you must complete and attach form LIC34. Yes No Have you ever been convicted or pled guilty to an offense anywhere an offense is defined as a violation misdemeanor or felony No Do you owe any penalties or fines to the City of New York No Does any company or business you have been associated with under your Department-issued license owe any fines penalties or fees to the City of New York that were incurred during your association with that company or business 10 Statements and Signatures As a condition of being granted a license I attest that I comply with all New York City Administrative Code and Department rules regulations and directives governing how licensees conduct their specific trade. I understand it is unlawful to make a false statement to the Department or to give to a city employee or for a city employee to accept any benefit monetary or otherwise either as a gratuity for properly performing the job or in exchange for special consideration* Such actions are punishable by imprisonment fine and/or loss of license. In the event of an accident that involves my actions undertaken in connection with my license I understand that the Administrative Code requires that I cooperate with any investigation and that failure to do so may result in immediate suspension revocation or other disciplinary action* Applicant Name Date Signature Internal Use Only Fee Paid Certificates Issued Expiration Date Clerk s Signature 11/08. Indicates optional* First Name Middle Initial Last Name Home Address Home Telephone Zip Mobile Telephone Date of Birth m/d/y City State Social Security No* E-Mail Driver License No 5 Business Information Indicates optional 6 License Use Business Name Office Telephone Office Address Office Fax Choose One Individual/Sole-Proprietor On Behalf of a Corporation Shop Address On Behalf of a Partnership Shop Telephone 7 Partner or Officer Information Name Address Lic No Control Phone Title s 8 Affiliation Complete this section only if you have additional affiliations for this license type other than the one listed on this application* 9 Convictions and Fines If you answer Yes to either of these questions you must complete and attach form LIC34. Yes No Have you ever been convicted or pled guilty to an offense anywhere an offense is defined as a violation misdemeanor or felony No Do you owe any penalties or fines to the City of New York No Does any company or business you have been associated with under your Department-issued license owe any fines penalties or fees to the City of New York that were incurred during your association with that company or business 10 Statements and Signatures As a condition of being granted a license I attest that I comply with all New York City Administrative Code and Department rules regulations and directives governing how licensees conduct their specific trade. .