TotalC Registration 2022'"t?Wse 0 a``
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:
Ci
CONTRACTOR REGISTRATION / LICENSE RENEWAL
TOTAL CONSTRUCTION SERVICES INC Please verify and correct the
company /business
6727 N 56TH ST Information listed here:
OMAHA NE 68152
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Type of Business: CONTRACTOR LICENSE
Contact information on record:
Type:
Phone Number:
Type:
Phone Number:
Work
402 572-7457
Fax
LAM, � 7 f,
Cell
402)306-0340
Email Address:
INFO MYTOTALCONSTRUCTION.COM
Please submit a current reciprocating license and NDOL_ for those which have expired:
Name:
Reciprocating License:
Expires:
TOTAL CONSTRUCTION
NDOL
11/01/2021
Please submit new certificates or bond renewals for those which have expired. -
Name:
Certificate of Liability or Bond:
Expires:
TOTAL CONSTRUCTION
GENERAL
3/01/2021
Place a check in the box next to the licenses you wish to renew. -
Renew?
Name:
License / Registration:
Expires:
Amount:
❑
TOTAL CONSTRUCTION SERVICES INC
CONTRACTOR LICENSE
1/01/2022
60.00
Please list aq�y additional licenses or registrations:
Name: 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 thei 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.
t ized Siena e Date
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