IdealH Registration 2019.tifCITY OF BLAIR
218S. 16th Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraska.org
FOR OFFICEUSE ONLY
Date Paid: 5 0
Receipt No:
Date Issued:
BOND EXPIRES:
Application is: ❑ New ❑ Renewal ID
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in ink — If you need more space, please attach additional sheets)
Application is for: >� Contractor- $60.00 ❑ Electrical Contractor - $60.00
❑ Water Service Line Installer- $60.00 ❑ Tree Trimmer- $60.00
❑ Fire/Security System Installer- $25.00 ❑ Gas Line Installer - $25.00
❑ Mechanical Contractor- $60.00 ❑ Plumbing Contractor- $60.00
❑ Drain Layer- $60.00 _
Business Name:
Applicant Name:_
Business Address:
Email Address:
Phone # V-
Business
Address outside of Nebraska:
City:
State
Contact Person: Co rw'%Ll Ke 1126
Zip: Phone:
Number of Employees: J Apprentices: Journeymen: 1
Other Licenses Held:
Insurance/Worker's Compensation Company:
0
General Contractors need to submit a Certificate of Insurance with minimum limits of $1,000,000 Aggregate/$300,000 each
occurrence with the certificate holder being the "City of Blair'.
All types of registrations must include proof of registration with the Nebraska Department of Labor.
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 I am competent and experienced to
engage in above said vocation. 1 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(/mor registration and—any renewals thereof.
Authorized Signature Date
CITY OF BLAIR
218 S. 16" Street
Blair, NE 68008
(402) 426 4191 FAX: (402) 426 4195
Email: building@blairnebraska.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No:
Date Issued:
BOND EXPIRES:
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in ink — If you need more space, please attach additional sheets)
Application is for:
Business Name:
Master's Name:
rentice - S2S_00 each
r : ��� �� —M/7
Business Address: - 5-V,4 City /( State: Zi'''p: F
Phone #: 60 �L� � ®l(/ Mobile #: 4`D "q�/D --R i Z"
Please List all employees that you wish to register and check the appropriate boxes.
Name
Plumber
Heater
Electrician
Apprentice
Journeyman
w'ry 5 .,4^
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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 I 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 ancWyy renewals thereof.
Authorized Signature
Date
NEBRASKA
Good Life. Great Connections.
DEPARTMENT OF LABOR
Les -1 i 14 • !
This certificate is non -transferable
Registration # 40955-19
Date Issued: 4/15/2019 Date E>piring: 4/15/2020
Ideal Heating and Air Conditioning, LLC
5366 F Street
Omaha, NE 68117
Nebraska Department of Labor
550 South 16th Street �.
Lincoln, NE 68508
402471-2239 &1ommissioner of Labor