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IdealH Registration 2022
"orrlise of a"., CITY OF BLAIR 218 S 16"' Sired Blair, NE 68008 (1102) 426-4191 Fax (402) 426-4195 Email: building@blain-tlebraska.org FQR OFFICE USE ONLY Date Paid: _- Receipt No: _ Date Issues: BOND EXPIRES: CONTRACTOR REGISTRATION / LICENSE RENEWAL C(b Please veriFy and correct the IDEAL HEATING AND AIR CONDITIONING corrr7rarrp/business -5166 F 5T I( a In%ruration listed here: OMAHA NE -68117 G) Type of Business: ('ONTRAC 011 UCIE ISE Contact information on record: I'y � Work Phone Number: Type: PhoneNumber: -- ------ --- ----- -- ---- (402)932-0649 Pax (402)714-9433 Cell (402)990 2677 _ u ------ -Email Email Address: CORWIN�JEATINGA_IROMAHA.COM MASTER MECHANICAL Please subinit a current reciprocating license and NDOL for those lahich have expired: Name: - CORWIN KELLER Reci rocaling Liceuse_ OlyWJA Expires: 12/31/2021 Please submit nely certificates or bona renewals for• those 1i7hich haveeked: Name: KELLER CORIAriN Certificate of Liability or Bond: _ —_ MECHANICAL _ _ _.._ ExLires: — 4/17/2050 IDEAL HEATING NDOL 4/15/2021 Pl�r�r� rr rhnrlc i7,) 1170 hm, 79Pr1 to iho %il'P72ClLC voil ivish tO r•erlell): Renew? Name: License / Registration: Expires., Amount: CCY KELLER. COR WIN MASTER MECHANICAL 1/01/2023 60.00 ©` DAVIES SERGEI APPRENTICE MECHANICAL 1/01/2023 25.00 M JONES KEVIN JOURNEYMAN MECIIA.NICAL 1/01/2023 25.00 Noose list arty adclitional licenses or r°epislrations: Namc,— —_ License / Regista anon: -- -- — t9 monist 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. 1 agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said vocation and obey at) orders, requirements and regulations of its lawful constituted authorities. ' I also certify 1:hat all information contained in this applicalioi1 is true and correct. I will notify the City of 131air of any changes in the information reported on or with this application form. within 15 days of any change. .T l�l t11 orize -- , 1 Signature bate I I&A N I UY 4- (D OD 0o I . (f) w Z LL (.0 Co LO 0E E E 0