2. 
3. City of Ponca City

   Development Services Department
   516 E. Grand
   PO Box 1450
   Ponca City, OK 74602
   Phone 580-767-0383
   Fax 580-767-0325

5. License Registration Form-MEP

7. License Desired*
8. Date
10. Applicant's Name
11. Phone Number:*
13. Applicant's Address
15. City
16. State
17. Zip
19. Business Name
20. Business Phone
22. Business Address
23. City
24. State
25. Zip
27. Email
29. Tradesman License (Check One)

    1. Electrical

    1. Contractor

    1. Journeyman

    1. Apprentice
31. 1. Plumbing

    1. Contractor

    1. Journeyman

    1. Apprentice
33. 1. Mechanical

    1. Contractor

    1. Journeyman

    1. Apprentice
35. State License #
36. You must include a copy of your current state license with this form.
38. City
39. State
40. Zip
42. Previous Employer if different than current employer (Company Name Only)
44. Registration Fee Schedule
46. A. For Contractors:

    1. For the first year or portion therof:  Three hundred dollars ($300.00)

    2. For subsequent renewals: Seventy-five dollars ($75.00)

48. B. For Journeyman:

    No Charge

50. C. For Apprentice:

    No Charge

52. If a contractor has not renewed his or her registation certificate by July 31, the fee shall be the same as the fee required for the first year. Individuals not renewed by this date will NOT be allowed to continue work in their respective trade within the City of Ponca City jurisdiction.
54. I HEREBY CERTIFY THAT ALL OF THE ABOVE STATEMENTS ARE TRUE AND CORRECT.
56. Date
57. Signature of Applicant*
58. $
62. Information For Development Services
64. Amount Collected $
65. By
66. Date
70. If mailing, please make check or money order payable to City of Ponca City and mail to: Development Services Department, P.O. Box 1450, Ponca City, OK 74602. Do NOT mail cash.
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit Submit and Print

* indicates a required field