Eyman Registration 2012.tif i
Y CITY OF BLAIR FOR OFFICE USE ONLY
218 S 16TH STREET
BLAIR, NE 68008 Date Paid:
(402) 426 - 4191
Receipt No:_
FAX(402)426 - 4195 Date Issued: —
BOND EXPIRES -
a� Email: cityofblair @ci.blair.ne.us
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Eyman Plumbing Inc. information listed here:
8506 S 117th St
LaVista, NE 68128
Phone numbers on record:
Type: Phone Number: Type: Phone Number:
Office 7312727
Mobile Fax: 7314538
Email Address:
Type of Business: PLUMBING
Please submit new reciprocating license for those which have expired:
Name Reciprocating License Expires
Tom Eyman Plumber Reciprocating 12/31/2011
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Tom Eyman Plumber Bond 12/31/2050
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
Tom Eyman Plumbing Contractor 12/31/2011 $60
Please list any additional license or registrations:
Name License / Registration Amount
__________________________________ _______________________________
______________________________
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 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.
Authorized Signature Date