TotalC 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: ,
Date Issues:
BOND EXPIRES:
CONTRACTOR REGISTRATION / LICENSE RENEWAL
TOTAL CONSTRUCTION SERVICES INC
6727 N 56TH ST
OMAHA NE 68152
Type of Business: CONTRACTOR LICENSE
Contact information on record:
Please verify and correct the
company / business
Information listed here:
Type:
Phone Number:
Type:
Phone Number:
Work
402 572-7457
Fax
402 572-0226
Cell
402 306-0340
Email Address:
INFO MYTOTALCONSTRUCTION.COM
Please submit a current 'reci wcatin license or 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 expired.'
Name:
Certificate of Liability or Bond:
Expires:
TOTAL CONSTRUCTION
GENERAL
3/01/2023
TOTAL CONSTRUCTION
NDOL
11/01/2022
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
1/01/2023
60.00
11
Pay this amount: ' 60.00
Please list any additional licenses or registrations.,
Name: I License / Re istration: 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.
I
Au orized Si nature Date
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