Luxa Registration 2022-�omise of 0'
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 Issues:
BOND EXPIRES:
CONTRACTOR REGISTRATION / LICENSE RENEWAL
LUXA CONSTRUCTION COMPANY INC Please verify and correct the
company /business
P O BOX 105 Information listed here:
BLAIR NE 68008
Type of Business: CONTRACTOR LICENSE
Contact information on record:
Type:
Phone Number:
Type:
Phone Number:
Work
402 426-2778
Fax
Cell
402 510-8200
Email Address:
Please submit a current reciprocating license and NDOL or those which have expired:
Name:
Reciprocating" License:
Expires:
LUXA CONSTRUCTION
NDOL
10/01/2021
Please submit new certificates or bond renewals. for those which have expired:
Name:
Certificate of Liability or Bond:
Expires:
LUXA CONSTRUCTION
GENERAL
8/01/2022
Place a check in the box next to the licenses you wish to renew. -
Renew?
Name:
License% Registration:
Expires:
Amount:
❑
LUXA CONSTRUCTION COMPANY INC
CONTRACTOR LICENSE
1/01/2022
60.00
Please list any additional licenses or registrations:
Name: I License / Registration: Amount:
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and
experienced to engage in the above said vocation.
I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said vocation and obey all
orders, requirements and regulations of its lawful constituted authorities.
I also certify that all information contained in this application is true and correct. I will notify the City of Blair
of any changes in the information reported on or with this application form within 15 days of any change.
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Authorized Signature Date
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