Notice Change of address or contact details Form 79 Change your details online Instead of using this form, change your details online at: www.commerce.wa.gov.au/building-commission/change-your-contact-details-online Use of this form If the online service is not for you, use this form to notify the of a Plumber’s Licensing Board change in a licence or contact details. Post the signed form to Locked Bag 14 permit holder’s Cloisters Square WA 6850, fax to 08 6251 1501 or email to plumbers@commerce.wa.gov.au. Licence or permit Please complete a separate form for each licence or permit holder. Licence or permit number licence licence Plumbing contractor’s Tradesperson’s licence (drainage plumbing) licence Tradesperson’s Provisional tradesperson’s licence (drainage Restricted plumbing permit Provisional tradesperson’s plumbing) License or permit holder Salutation Mr Mrs Ms Other please specify Family name First name Other name(s) Date of birth Address a street address, not a post office box. Street Suburb State Postcode Postal address if different to address above. Street or PO Box Suburb State Postcode Contact details – not published in the register. Phone (home) Phone (work) Phone (mobile) Fax Email Date of effect Preferred date of effect of this notice / / or effective immediately. Signed by the licence or permit holder Signature Date
Notice Change of address or contact details Form 79 Change your details online Instead of using this form, change your details online at: www.commerce.wa.gov.au/building-commission/change-your-contact-details-online Use of this form If the online service is not for you, use this form to notify the Plumber’s Licensing Board of a change in a licence or permit holder’s contact details. Post the signed form to Locked Bag 14 Cloisters Square WA 6850, fax to 08 6251 1501 or email to plumbers@commerce.wa.gov.au. Licence or permit Please complete a separate form for each licence or permit holder. Licence or permit number Plumbing contractor’s licence Tradesperson’s licence Tradesperson’s licence (drainage plumbing) Provisional tradesperson’s licence Provisional tradesperson’s licence (drainage plumbing) Restricted plumbing permit License or permit holder Salutation Mr Mrs Ms Other please specify Family name First name Other name(s) Date of birth Address a street address, not a post office box. Street Suburb State Postcode Postal address if different to address above. Street or PO Box Suburb State Postcode Contact details – not published in the register. Phone (home) Phone (work) Phone (mobile) Fax Email Date of effect Preferred date of effect of this notice / / or effective immediately. Signed by the licence or permit holder Signature Date
form_79_notification_of_change_of_address_or_contact_details_plb_20150123_0.docx