Jorgensen Registration 2024CITY OF BLAIR
218 S 161h Street
Blair, NE 68008
(402) 426-4191
Fax (402) 426-4195
Email: building@blairnebraska.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No: L
Check # or CC: -) fK
Amount Paid:
CONTRACTOR REGISTRATION / LICENSE RENEWAL
JORGENSEN CONTRACTING INC
530 FRONT ST
BLAIR NE 68008
Type of Btisiness: CONTRACTOR LICENSE
Contact information on record:
Please verify and correct the
company / business
hiformation listed here:
Type:
Phone Number:
Type:
Phone Number:
Work
402 426-4440
Fax
402 426-8323
Cell
402 533-3165
Email Address:
JCI ABBNEBRASKA.COM
Please submit a current reciprocating 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 exnired..'
Name:
Certificate of Liability or Bond:
Expires:
JORGENSEN CONTRACTING INC
GENERAL
1/01/2024
JORGENSEN CONTRACTING INC
NDOL
1/01/2024
Place a check in the box next to the licenses you wish to renew
Renew?
Name:
License / Registration:
"'' Expires:
Amount:
❑
JORGENSEN CONTRACTING INC
CONTRACTOR LICENSE
1/01/2024
60.00
Pay this amount: 60.00
Please list any additional licenses or registrations. -
Name: I License / Re istration: Amount:
I hereby make an 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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