Gretna Registration 2024(03TY OF SLAlk
Blair,': 0,
i!` ! Ir(P blairnebraska.org
FOR OFFICE USE ONLY
Date Paid:
Receipt No: — ? i✓
Date Issued: _ i �t
BOND EXPIRES:
Application is: ❑ New 0 Renewal
CONTRACTOR RE IST TION/LICENSE RENEWAL
(Neas,e 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- $2S.00
❑ Mechanical Contractor - $60.00
M Plumbing Contractor - $60.00
Business Name: Gretna Plumbing & Drain Services LLC
Applicant Name:John Ellis
Business Address: 988 Burns PI
City:
❑ Tree Trimmer- $60.00
❑ Drain Layer- $60.00
❑ Fire -Security System Installer-$60.00
❑ Water Service Line Installer - $60.00
Gretna
State: NE Zip:68028
Mailing Address: City: State: Zip:
Email Address:John@gretnaplumbing.com,adrian@gretnaplumbing.com
Phone #• 402-991-2770 Fax #: Mobile #:402-968-2819
Business Address outside of Nebraska:
M
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Zip: Phone:
Contact Person: Adrian Hunter -Office manager(AR/AP/LICENSE/PERMITS)
Number of Employees: 5
Apprentices: 5
Journeymen: 5
Other Licenses Held: OMAHA/SELLEVUE/VALLEY/ASHLAN D/PAPILL ION/AN D MORE
Insurance/Worker's Compensation Company: InsPro
General Contractors need to submit a Certificate of Insurance with minimum limits of $1,000,000 Aggregate/$300,000 each
occurrence with the ceE 1ficate holder being the "City of Blair".
All types of registrations must include proof of registration with the Nebraska Department of Labor.
All Information cads �aii 3ec1 I�A this application is true and correct. I will notify the City of Blair of any changes in the information
reported on or with e'hL a;_,, Idcation form within IS days of the change.
hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to engage in
above said vocation. I agree to conform ictly to the Ordinances of the City of Blair, Nebraska relative to said vocation and obey
all or . reg ements anti re do of its lawful constituted authorities. This certification applies to the original license and/or
regi r ion ny r
4/26/24
t i ized Sig aturDate
CITYOF BLAIR FOR OFFICE USE ONLY
Date Paid:
21 B S, 1 6th Street Receipt No:
Date Issued:
Blair, NE 68008 BOND EXPIRES:
(402) 426 4191 FAX: (402) 426 4195
Email: building(Pblairnebraska.org
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in Ink — If you need more space, please attach additional sheets)
Application is for: Journeymen/Apprentice - $25.00 each
Business Name: Gretna Plumbing & Drain Services LLC
Master's Narne:John Ellis
Business Address: 988 erns P1 pit,: Gretna State: NE Zip:68028
Phone #: 02-991-2770 Mobile #:402-968-2819
Please List all employees that you wish to register and check the appropriate boxes.
Name Plumber Heater Electrician Apprentice Journeyman
Francisco Salazar ®
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Derek Carmody
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All information contained in this application is true and correct. 1 will notify the City of Blair of any changes in the information
reported on or with this application form within I S 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. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and obey all order, requirem s and regulations of Its lawful constituted authorities. This certification applies to the
on n lic e and/or registra ' n d an renewals thereof.
4/26/24
authorized Signature Date
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