Eyman Registration 2013.tif i
CITY OF BLAIR FOR OFFICE USE ONLY
` 218 S 16TH STREET
BLAIR, NE 68008 Date Paid.
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(402) 426 - 4191 Receipt No: -�
-ra FAX (402) 426 - 4195 Date Issued:
fk oo Email: cityofblair @ci.blair.ne.us BO EXPI RES_ —
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: PLU MBING
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Eyman, Tom 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
Eyman, Tom Plumbing Contractor 12/31/2012 $60
Please list any additional license or registrations:
Name License / Registration Amount
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
WJUN L ( C
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All information contained in this application is true and correct. I will notify the City of Blair of any changes in the
information reported on or with this application form within 15 days of change.
I hereby make application to the Licensing Board of Blair, Nebraska and certify that I am competent and experienced to
engage in above said vocation. I agree to conform strictly to the Ordinances of the City of Blair, Nebraska relative to said
vocation and obey all order, requirements and regulations of its lawful constituted authorities.
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Authorz d Signature . Date
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FROM:Eyman Plumbing TO:4024264195 11/14/2013 15:57:37 #83605 P.002/007
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FOR OFFICE USE ONLY
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IPate Paid:
218 S. 16 Street Receipt Nat e
Viote issued, li - L
Blair, 111E 68008 BOND1FXPIRE$-
(402) 426 4191 FAX: (402) 42 4195 i
Email: cltyofb_l.��rC�ci.l�lair.neaLls
Application is: [3 New 0 Renewal
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CON TRACTO R REGISTRATION/LICENSE R ENEWAL
(Please type or print In Ink - If you need more space, please attach additional sheets) �
Application is for: # Contractor $60.00 0 Electrical Contractor $ 60.00
® Water Service Line I - $60.00 d Tree Trimmer $60.QQ
Fire /Security System Installer- $25.00 ® Gas Line Installer - $25.00
Mechanical Contractor- $60.00 ® Plumbing Contractor- $60.00
0 Drain Layer- $60.00
Business Name: *K Acin >'u� r 091',
Applicant Name:"
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Business Address: 9 -0 6 -T° // City: Lea V,4-1- State: 11 W Z1p: 9/09
Email Address: 'fi w Q cj 6.6
Phone #: 1 -104 - �71� 7 _ Fax �: °0�� 7I - ys Moene #: ® '71 S�
Business Address outside of Nebraska:
City: State Zip: Phone:
Contact Person:
I
Number of Employees: Apprentices: _ _ ' - Journeymen: ___ _ 0
Other Licenses Held: #
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Insurance/Worker's Compensation Company: I
Grain i.ayers/Igiectrlcal, Plumbing and Mechanical Contractors/Water Service Line Installers need a $5,000 permit bond In favor
Of the City of Blair. Tree Trimmers need a $5,000 permit bond in favor of the City of Blair. Electrical contractor and Fire
Security Systems Installer will need to submit a copy of your Nebraska State License.
General Contractors creed to submit a Certificate of insurance with minimum limits of S 1,000 000 Aggregate/$300,000 each
occurrence.
All Information contained in this application Is true and correct. I will notify the City of Blair of any changes in the Information
reported an or with this application form within 15 days of the change.
I hereby make application to the Licensing Board of elalr, Nebraska and certify that I am competent and experienced to
engage In above said vocation. 1 agree to conform strictly to the Ordinances of the Clay of Blair, Nebraska relative to said
vocation and obey all order, requirements and regulations of Its lawful constituted authorities. This certification applies to the
original license and/or registration and any renewals thereof.
Authorized Signature Date
FROM:Eyman Plumbing TO:4024264106 11/14/2013 15:57:57 #83605 P.004/007
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FOR OFFICE USE ONLY
18 S. 1 Pa Strut ceipt
Date Issued:
Blair, NE 68008 BOND EXPIRE
(402) 426 4191 FAX (402) 426 4195
Email: rjWofb1alr@cl.blajr.ng.us
CONTRACTOR REG ISTRA TION /LICEN SE R ENEWAL
(Please type or print In Ink - If you need more space, please attach additional sheets)
Application is for: Journeymen/Apprentice- $25,00 each
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Busi Name. C.l YLr y �cfv 't Y L l• 'ws .--
Masters Name: 2 2 ,
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Business .'#ddress;� city: State: , Zip:
Phone 7 � ��
e: 7G�.� I � � -� � M ®bile#.
Tease List all employees that you wish to register and check the appropriate boxes.
f�dame PluMber Heater ...Electr1clan Apprel3tice
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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 Farm 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. This certification applies to the
original license and /or registration and any renewals thereof.
i
i
Authorized signature Cate
.................... .