Eyman Registration 2010.tif i
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rDatePaid: OFFICE USE ONLY
CITY OF BLAIR
218 S. 16TH STREET BLAIR, NE 68008 o: (402) 426 -4191 ed: ✓�
FAX (402) 426 -4195 P
BOND EXPIRES:
email: CityofBlair@huntel.net
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CONTRACTOR REGISTRATION / LICENSE RENEWAL
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Verify the following information:
Business Name: Eyman Plumbing Inc.
Address Tom Eyman
8506 S 117th St
LaVista, NE 68128
Phone # 731 2727
Mobile # Fax: 7314 538
men: Apprentices:
Journeymen: Number of Employees: 50 Y
Type of Business: Plumbing
Other Licenses Held:
Insured? Yes Worker's Compensation? Yes
Place a check in the box next to the licenses you wish to renew:
Renew? Name
License / Registration Bond Expires Amount
Tom Eyman
Master Plumber (Omaha Plumbing $60.00
List additional license / registrations Bond Expires Amount
Name License /Registration
Please submit a copy of your
current City of Omaha License
All information contained
on or l w'Ithp application for within 15 days of the change.Blair of any changes in
the information report
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, requirements and regulations of its lawful
constituted authorities.
Date
Au orized Signatur