RENEWAL REGISTRATION APPLICATION FOR PLUMBERS CERTIFICATE
Utility / Septic Installer / Apprentice
220 SOUTH MAIN STREET
BEL AIR, MARYLAND 21014
(410) 638-3215
FAX (410) 879-8203
UTILITY CERTIFICATE $90 JOURNEY UTILITY $30
SEPTIC INSTALLER CERTFICATE $90 JOURNEY SEPTIC INSTALLER $30
APPRENTICE PLUMBER GAS FITTER $10
This a two year license which renews October 31
st
of even numbered years.
NAME: _____________________________________________________________________________
LAST FIRST MI
APPLICANT ADDRESS: ______________________________________________________________
CITY/STATE/ZIP: ________________________________________ PHONE: ___________________
APPLICANT E-MAIL: ________________________________________________________________
FIRM NAME: ____________________________________________PHONE:____________________
FIRM ADDRESS_____________________________________________________________________
FIRM E-MAIL: ______________________________________________________________________
APPLICANT SIGNATURE: __________________________________________ DATE: ___________
Revised Oct 2020
Please Provide Payment and the Following Documents at the Time of Your Application
Certificate of Insurance Naming Harford County Plumbing Board as Certificate Holder
Osha Training Certificate for Confined Spaces & Subpart P in Trench Safety if the
County does not have a current certificate on file
Renewal Application Noting any Changes in Contact Information
CLEAR FORM
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signature
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