RENEWAL
APPLICATION FOR MECHANICAL REGISTRATION
220 SOUTH MAIN STREET
BEL AIR, MARYLAND 21014
(410) 638-3215
FAX (410) 879-8203
□ JOURNEYMAN $30
□ APPRENTICE $10
This is a two year license which renews October 31
st
on even numbered years.
PLEASE PROVIDE THE FOLLOWING DOCUMENTS AT THE TIME OF YOUR APPLICATION:
STATEWIDE LICENSE
DRIVER’S LICENSE
NAME: __________________________________________________________________________________
LAST FIRST MI
ADDRESS: _______________________________________________________________________________
________________________________________________________________________________
COMPANY NAME: ________________________________________________________________________
COMPANY ADDRESS: _____________________________________________________________________
________________________________________________________________________________
TELEPHONE: ____________________________________CELL PHONE: __________________________
EMAIL: __________________________________________________________________________________
SIGNATURE: __________________________________________DATE:_____________________________
Rev Oct 2020
