Luxa Registration 2013.tif Jan. 14, 2413 12:37PM LUXA CONSTRUCTION No, 2404 P. 1
C ITY OF BLAIR POR OFFICE USE ONL i
218 S 16TH STREET
BLAIR, NE 58008 Date Paid: ° I
(402) 426 m 4191 I Receipt No: �� • - ;�
Date Issued:
y , ,�• FAX (402) 426 - 4195 BOND EX PIRES`.......
P ° j�+ise of �"n�y Email: c1tyofbla1[r @ci.blafr.ne.us
i
CONTRACTOR REGISTRATION / LICENSE RENEW
Pfease verify and correct
the company /business
Luxa Construction Company, Inc. '. Information Ilstedhere,
925 E Dixon Rd
Blair, NE 68008
Phone numbers on record:
T P Number: Type: Phone Numbe
office 402 -426 -2778
Mobile 402 510 8200
Email Address: _.. -
Type of Business: _0E N.ERAL --- - .-
�- 's` -�" 7IF4; ,pr'o�d;enewa those -which `kiaVe expired-"
Name Certificate of Liability or Bond Expires
a.....• fir._. 1
,v:aSr..:..,:
ertif�ca of Llabi�: sJ1 %2d'IZ...�
Benera. C "
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
j Luxa, Mike General Contractor 12/31/2012 $60
—
Please list any additional license or registrations: Amount
Name License J Registration
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 ob all a equi ents and regulations of Its lawful constituted authorities.
;_r,k 'Date