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Revised 2/9/2023 Page 1 of 2 ALLEN COUNTY, INDIANA BUILDING DEPARTMENT 200 E Berry St, Ste 180 Fort Wayne, IN 46802 Phone: (260) 449-7131 Joseph Hutter, Building Commissioner Mechanical/Trade Exam Application + $25 Sponsorship PLEASE PRINT CLEARLY (only select 1 exam per application) ICC Mechanical/Trade Exams Electrical ☐ Journeyman ☐ F17 - 2014 Codes ☐ G17 – 2017 Codes ☐ T17 – 2020 Codes ☐ Master ☐ F16 - 2014 Codes ☐ G16 – 2017 Codes ☐ T16 – 2020 Codes HVAC ☐ Journeyman ☐ F31 - 2015 Codes ☐ G31 – 2018 Codes ☐ Master ☐ F29 - 2015 Codes ☐ G29 – 2018 Codes Non-Sanitary Gas Pipe Fitter ☐ Journeyman ☐ F34 - 2015 Codes ☐ G34 – 2018 Codes ☐ Master ☐ F33 - 2015 Codes ☐ G33 – 2018 Codes Prov Mechanical/Trade Exams HVAC ☐ Sheet Metal Journeyman ☐ Sheet Metal Master Non-Sanitary ☐ Boiler Low Pressure ☐ Boiler Unlimited ☐ Refrigeration Limited ☐ Refrigeration Unlimited License presently held (please complete info): Apprentice Years Months Journeyman Years Months Applicant Information First Middle Initial Last Address City State Zip Phone # Email Address Employment Information / Field Experience Present Employer Years Months Address City State Zip Contact Phone # Previous Employer Years Months Address City State Zip Contact Phone # Signature REQUIRED on page 2. ---PAGE BREAK--- Revised 2/9/2023 Page 2 of 2 Employment Information / Field Experience Continued Present Employer Years Months Address City State Zip Contact Phone # Detail of work performed (including Military Service) List any formal training and schooling in field The undersigned warrants the information submitted is true. Signature of Applicant Date If mailing in your application, would you like your exam information mailed or emailed? ☐ Mailed ☐ Emailed Internal Office Use Only Received Date: Paid, Processed & Mailed/Emailed Date: Passed Date: Signature REQUIRED on this page.