Eyman Registration 2014.tif CITY OF B LAIR FOR OFFICE USE ONLY
218 S 16Th STREET
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BLAIR, NE 68008 Date Paid: �� I
(402) 426 - 4191 Receipt No: mac;
Date Issued:
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FAX(402)426 -4195
Email: cityofblair @ci.blair.ne.us BOND EXPIRES
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 Please submit a copy of your
Mobile Fax: 7314538 current City of Bellevue License
Email Address: LIC-LO
Type of Business: PLUMBING
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Please submit new reciprocating license for those which have expired:
Name Reciprocating License Expires
Eyman, Tom Bellevue Plumber License 12/31/2013
b Omaha Mechanical License 12/31/2013
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:
Rene Name License / Registration Expires Amount
Eyan, Tom Plumbing Contractor 12/31/2013 $60
Y Mechanical Contractor 12/31/2013 $60
Please list any additional license or registrations:
Name License / Registration Amount
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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.
Authorized Signature Date