PremierEx Registration 2014.tif FOR OFFICE USE ONLY
CITY OF BLAIR Date paid:
1h Receipt Nc�. �--219!C �6�
2 18 S. 16 Street Datelssued:
Blair OND EXPIRES'.
NE 68008 B
(402) 426 4191 FAX: (402) 426 4195
Email: djyofblair@ci.bla1r.ne.us Application is: New 0 Renewal
CONTRACTOR REGISTRATION/LICENSE RENEWAL
(Please type or print in Ink — if y ou need more space, please attach additional sheets)
Application Is for: Contractor - $60-00 Electrical contractor - $60.00
Water Service Line Installer- $60.00 0 Tree Trimmer- $60.00
Fire/security s installer - $25-00 Gas Line installer - $25.00
❑ Mechanical Contractor- $60.00 Plumbing Contractor - $60.00
Drain La - $60.00
Business Name:
ApplicantName..
'1-3
city: 7
Business Address: Y 7SO' 3� OU:th 13 1-- State. zip:
Email Address: I i 0- 1/1) - Q' I Coro
Phone Fax #: Mobile #:
Business Address outside of Nebraska:
City: State --- Zip: Phone.
Contact Person:
A pprentices: Journeymen:
Number of Employees: A.
Other Licenses Held; —L MLS L� L c /
Insurance/Worker's Compensation Company
Drain L Plumbing and Mechanical Contractors/Water Service Line Installers need a S s,000 permit bond In favor
of the City of Blair. Tree Trimmers need a ss.000 permit bond In favor of the City of Blair. Electrical contractor and Fire
s ecur it y s installer will need to submit a copy of your Nebraska state License.
General Contractors need to submit a certificate of Insurance with minimum li o f $ 1,000000 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 on or with this application form within I S 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 con stricti 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 livens and/or registration and any renewals thereof.
Authorized Signs ure Date
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GENERAL, CONTRACTOR REGISTRATION REFERENCES
Due to the large number of general contractors seeking roofing and siding work within the
zoning jurisdiction of the City of Blair, the following reference information is required.
References will be checked, so please ensure reference names and phone numbers are
current,
NO WORK SHOULD BE DONE PRIOR TO RECEIVING
A GENERAL CONTRACTOR REGISTRATION.
Three communities in which you are currently registered and have been issued permits,
Community #1 ; Phone:
Community #2: � Phone:
Co mmunity # i Phone, - ;
Three personal references for whom you have recently done work:
Client #1 . ky
( t Phone: 9
`r
Client #2 , , Phone. � #� / S
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Client #3 � u Phone..
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ntractor /Ap icant bate
References verified by. Gate
218 South 16th Street • Blair, Nebraska 6800 402 -426-4191 . Fax 402.426 -4145 E-mail cityoJ`blalt CLblolt,ne,u
I
JUN -5 -2014 09 :19A FROM: TO:402SM9490 PA
t
vivo Department of Labor
14bor law / Contractor R4stration
NEBRASKA 550 5outb 16th Strec4 3rd noor
DEPARTMENT OF 1ABOR -L,incotn Id' s . + + 8508
Registered Contractors and Subcontractors Ucatar
Contractor/Subcontractor Name: PREMIER EXTERIORS INC.
Address: 4780 SO 131 ST SUITE 139
City: OMAHA
State: NE
Zip: 68137
Telephone,
Certificate Number; 23800
Certificate Expiraition: 06/01/2015
Contractor Option: 2
CITY OF OMAHA, Nebraska
NO. 00384
THIS CERTIFICATE IS NOT TRANSFERABLE
NAME James Pull LOCATION
James Pull
Premier Exteriors, Inc.
4685 Vinton Street Premier Exteriors, Inc,
Omaha, NE 68106 4685 Vinton Street
Omaha, NE 68106
Class C Building Contractor $200,00
POST IN A CONSPICUOUS PLACE EFFECTIVE DATE 15-Feb-2012
EXPIRATION DATE 31 -Dec-2015
DIVISION Per its & lnspectjon
City of Omaha Planning Department BY
1819 Farnam Street Room 1100
Omaha, NE 68183