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Application for Professional License
Company Name
Type of License
License Number
License Desc.
Requester Details
Contact Name
Address
City
State
Zip
Phone
Email
Fed ID#
State ID#
Activity Type
Applied Date
(mm-dd-yyyy)
Date of Issue
(mm-dd-yyyy)
Date of Expiry
(mm-dd-yyyy)
Fee
Add section
Reference Item Type
Business License
Code Enforcement
Inspection
Permit
Plan
Professional License
Reference Item Number
Date
(mm-dd-yyyy)
Fee Amount
Payment Method
Cash
Check
Debit/Credit Card
Payment ID
Reversed Date
(mm-dd-yyyy)
Reversed Amount
Description
Remove
Inspection Number
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