Eyman Registration 2011.tif i
FOR OFFICE USE ONLY
CITY OF BLAIR 1457 I
218 S. 16TH STREET Date Paid: °" r
BLAIR NE 68008
� Receipt No: a 7 11
(402) 426 -4191 Date Issued: li - � b -
�'� FAX (402) 426 -4195
email: CityofBlair@huntel.net BOND EXPIRES: Ott
4
P romise o (Continued)
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information:
i
Business Name: Eyman Plumbing Inc.
Address Tom Eyman
8506 S 117th St
LaVista, NE 68128
Phone # 731 2727
Mobile # Fax: 7314 538
i
i
Number of Employees: 50 Journeymen: Apprentices:
Type of Business: Plumbing
Other Licenses Held:
i
Insured? Yes Worker's Compensation? Yes
Place a check in the box next to the licenses you wish to renew:
I
Renew? Name License / Registration Bond Expires Amount
Tom Eyman Master Plumber (Omaha Plumbing $60.00
List additional license /registrations:
Name License / Registration Bond Expires Amount
Please submit o copy o f your
current City of Omaha License
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 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, requirements and regulations of its lawful
constituted authorities.
�.,,
Aut zed Signature Date