NatureWorks 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: j — / fl` 0)
Receipt No: 7
Check # or CC:
Amount Paid:
CONTRACTOR REGISTRATION / LICENSE RENEWAL
NATUREWORKS LLC Please verify and correct the
company / business
P O BOX 564 Information listed here:
BLAIR NE 68008
Type of Business: CONTRACTOR LICENSE
Contact information on record:
Type:
Phone Number:
Type:
Phone Number:
Work
402 237-3841
Fax
402 237-2801
Cell
402 306-6984
Email Address:
STEVE BRAY NATUREWORKSLLC.COM
Please submit a current reciprocating license for those which will or have expired.,
Name. Reciprocating License: Expires:
Please submit new cer°tifrcates or bond renewals and NDOL or those which will or have ex fired;
Name:
Certificate of Liability or Bond:
Expires:
NATUREWORKS LLC
GENERAL
12/01/2024
NATUREWORKS LLC
NDOL
10/01/2023
Place a check in the box next to the licenses you wish to renew. -
Renew?
Name:
License / Registration:
Expires:
Amount:
❑
NATUREWORKS LLC
CONTRACTOR LICENSE
1/01/2024
60.00
Pay this amount: 60.00
Please list anv additional licenses or
Name: I License / Registration: I 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.
Authorized Signature
/ �// C� AZO 4-3
Date
a