PrairieC Registration 2023CITY OF BLAIR
218 S 16th Street
Blair, NE 68008
(402) 426-4191
Fax (402) 426-4195
Email: building@blairnebraska.org
PRAIRIE CONSTRUCTION
13316 B ST
OAMAHA NE 68144
Type of Business: COT-17-PA- CTOR LICENSE
Contact information on record:
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FOR OFFICE USE ONLY
Date Paid: o
Receipt No:
Date Issues:
BOND EXPIRES:
Please verify and correct the
company / business
Information listed here:
Type:
Phone Number:
Type:
Phone Number:
Work
402 330-8522
Fax
402 330-8544
Cell
Email Address:
MATT PRAIRIE-CONSTRUCTION.COM
Please submit a current reciprocating license_ for those which will or have expired:
Name: Reciprocating License: Expires:
Please submit new certificates or bond renewals and NDOL for those which will or have ex fired.
Name:
Certificate of Liability or Bond:
Expires:
PRAIRIE CONSTRUCTION
GENERAL
1/01/2023
PRAIRIE CONSTRUCTION
NDOL
10/01/2022
Place a check in the box next to the licenses you wish to renew. -
Renew?
Name:
License / Registration:
Ex ires:.
Amount:
❑
PRAIRIE CONSTRUCTION
CONTRACTOR LICENSE
1/01/2023
60.00
0
0
0
0
0
Pay this amount:
Please list any 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 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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