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CITY OF BLAIR
218S16 TH STREET
BLAIR, NE 68008 .. �� Renewal
(402) 426-4191
FAX (402) 426-4195
EMAIL: building@Bla!rNebraska.org
Eyman Plumbing Inc
8506 S 117th St
LaVista, NE 68128
January 12, 2017
Contractor Registration Report
License Number: LCL201500162
License Issued To: License Type: Expires:
Rybin, Jay
Eyman, Tom
Bond Issued To:
Rybin, Jay
Eyman, Tom
Mechanical Contractor Master License
Plumbing Contractor Master License
Bond Type:
Mechanical Bond
Plumber Bond
Issued by: U'
Brenda Wheeler, City Clerk
12/31/2017 '4
12/31/2017 A rj
Expires:
11/12/291'7" l
09/24/20+7 )
218 S. 16th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraslca.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No: _
Date Issued:
BOND EXPIRES:
CHANGE/ADDITIONS FORM
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in ink— if you need more space, please attach additional sheets)
Master Plumber/Heuer/Electrician - $60.00 each
Application is for: Journeymen/Apprentice - $25.00 each
Business Name: rnAry �' ►+1 b ! ►�' `i
E -Mail Address: L 15 V /A,%/V s T f- C' 0 I
Phone #: 410 ° - 7 a/- Mobile
Please List all employees that you wish to register and check the appropriate boxes.
Name Master Plumber Heater Electrician Apprentice Journeyman
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All information contained in this application is true and correct. 1 will notify the City of Blair of any changes in the information
reported on or with this application form within 15 days of the change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that 1 am competent and experienced to
engage in above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and obey all order, requirements and regulations of its lawful constituted authorities. This certification applies to the
original license and/or registration and any renewals thereof.
1� 2.
uthorized Signatu a Date
Date Issued
9/15/2017
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DEPARTMENT QP LABOR
Nebraska Department of Labor
Contractor Registration
550 So. 16th Street, Lincoln, NE 68508
(402) 471 - 2239
CONTRACTOR REGISTRATION CERTIFICATE
This certificate is non -transferable
Fee Paid: $40.00 Registration #
21387
Date Expires
9/15/2018
Year
17
Business: o�
EYMAN PLUMBING, INC.
8506 S. 117TH STREET -- LAVISTA, NE 68128
Comnissioner of Labor