Eyman Registration 2023CITY 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: o
Date Issues:U
BOND EXPIRES:
CONTRACTOR REGISTRATION / LICENSE RENEWAL
EYMAN PLUMBING Please verify and correct the
compmry / business
8506 S 117TH ST brfonitation listed here:
LAVISTA NE 68128
Type of Business: CONTRACTOR LICENSE
Contact information on record:
Type: Phone Number: Type: Phone Number:
Work (402)731-2727 Fax (402)731-4538
Cell
Email Address: '-JRY TRUSTEYMAN.COM
Please submit a current reciprocating license or those which will or have expired:
Name: Reciprocating License: Expires:
EYMAN TOM OMAHA 12/31/2022
Please submit new certificates or bond renewals and NDOL for those which will or have expired.
Name:
Certificate of Liability or Bond:
Expires:
EYMAN TOM
PLUMBING
9/24/2023
EYMAN PLUMBING
NDOL
9/15/2022
Place a check in the box next to the licenses you wish to renew:
Renew? Name: License / Registration: Expires: Amount:
❑ EYMAN TOM MASTER PLUMBER 1/01/2023 60.00
CITY OF BLAIR
218S. 16th 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:
Application is: ❑ New ,Renewal
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
❑ Gas Line Installer - $25.00
❑ Mechanical Contractor - $60.00
Plumbing Contractor - $60.00
Business Name:
Applicant
E
❑ Tree Trimmer - $60.00
❑ Drain Layer- $60.00
❑ Fire -Security System Installer -$25.00
❑ Water Service Line Installer - $60.00
Business Address: a _ 0 (a 5 I 7 i� �' S? City: L. � U 1S fA State: N 0� Zip: G P
Mailing Address:
Email Address: C
Phone #: -41' 02 -
Business Address outside of Nebraska:
City:
Contact Person:
Number of Employees:
Other Licenses Held:
State
City:
#• Mobile #•
Apprentices:
Zip: Phone:
State: Zip:
Journeymen:
Insurance/Worker's Compensation Company: N a- "h- a k o
Electrical, Gas Line Installer, Mechanical, Plumbing Contractors and Tree Trimmers need a $5,000 permit bond stating "John Doe
dba Company Name" in favor of the City of Blair. Electrical Contractor and Fire Security Systems Installer will need to submit a
copy of your Nebraska State License.
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. I 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/or
registration and any renewals thereof.
l ,2 o Z Z--
Authorized Signat a Date
Contractor Details
Contractor/Subcontractor Name
Corporation Name
Business Entity
Address
City
i
State
Zip
i
Telephone
i
Registration Number
Registration Expiration
Sales Tax Option
Number of Employees
Worker's Compensation Status
EYMAN PLUMBING, INC.
EYMAN PLUMBING, INC.
Corporation
8506 S. 117TH STREET
LAVISTA, NE 68128
LAVISTA
NE
68128
(402) 731-2727
21387-22
9/15/2023
1
130
Certificate on File