Fillable Change of Address List all the certificate or (Washington)

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Change of Address List all the certificate or (Washington)

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Country of origin: US
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Department of Labor and Industries
Electrical Licensing
PO Box 44460
Olympia WA 98504-4460
www.Lni.wa.gov/Electrical
Request for
Change of Address
List all the certificate or license numbers that you wish to have the address changed. If you hold
more than one license or certificate, you must supply each number you want updated.
** We will only change the address on the numbers that you have listed. **
You may either mail to the above address or email to Electricalprogram@Lni.wa.gov. Address
changes may also be made online by going to: www.Lni.wa.gov/TradesLicensing/Electrical
Name of license or certificate holder
Electrician certificate number
Administrator certificate number
Master Electrician certificate number
Electrical trainee certificate number
Electrical contractor license number
Electrical contractor UBI#
The new address is:
Mailing/Street Address
Apartment or Suite #
City
State
Phone Number
Email Address
Signature of license or certificate holder
F500-044-000 Request for Change of Address 08-2016 Index: ADDR
RESET
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Change of Address List all the certificate or (Washington)

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Completed 22 January 2021

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