USM Registration 2011.tif I
FOR OFFICE USE ONLY
CITY OF BLAIR 1628 g'
218 S. 16TH STREET Date Paid:
BLAIR, NE 68008 Receipt No: 0277
(402)426 -4191 -4195 -4195 Date Issued: I -' i 0 — )V(
FAX (402) 426
BOND EXPIRES:
email: CityofBlair @huntel.net
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Promise (Continued)
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CONTRACTOR REGISTRATION / LICENSE RENEWAL
Verify the following information;
Business Name: US Mechanical Service Inc.
–' Craig Labs
1 �' or roo �Q� i �,,I v U.S. MECHANICAL. SERVICE, INC.
1209 ROYAL DR.
$ � ► ,05 �0.�1 If i > �� toFS` PAPILLION. NE 68046
Phone # 402 - 991 -2 899
Mobile # 402 - 657 -6 600
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Number of Employees: 7 Journeymen: 3 Apprentices: 2
Type of Business: Mechanical
Other Licenses Held:
Insured? No Worker's Compensation? No
Place a check in the box next to the licenses you wish to renew:
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Renew? Name License / Registration Bond Expires Amount
Craig Labs Master Heater 03101/2011 $60.00
Mike Sorensen Apprentice Heater $25.00
3 0 �
Kyle Schnoor Journeyman Heater $25.00
List additional license / registrations:
Name License / Registration Bond Expires Amount
our
Please submit a COPY of Y
Current City of Bellevue 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.
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