Skyline Registration 2015.tif i
_ CITE( OF BLAIR FOR OFFICE USE ONLY
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r ' 218 S 16TH STREET 1
' BLAIR, NE 68008 Date Paid:
' Receipt No:
(402) 426 - 4191 Date Issued:
FAX (402) 426 - 4195 B EXPIRES*
Email: cityofbiair @ci.blair.ne.us --
CONTRACTOR REGISTRATION / LICENSE RENEWAL
Please verify and correct
the company /business
Skyline General Contracting I information listed here:
716 Beaver Lake Blvd
PLATTSIVIOUTH, NE 68048
Phone numbers on record:
Type: Phone Number Type: Phone Number:
Office 402 235 3999 Office
Mobile 402 960 4918
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Email Address:
Type of Business: Ge neral
Please submit new certificates or bond renewals for those which have expired:
Name Certificate of Liability or Bond Expires
Rayer, Nicholas General Certificate of Liability 5/1/2015
Place a check in the box next to the licenses you wish to renew:
Renew? Name License / Registration Expires Amount
�V Rayer, Nicholas General Contractor 12/31/2014 $60
Please list any additional license or registrations:
Name License / Registration Amount
PLEASE SUBMIT A COPY OF YOUR
CURRENT NEBRASKA DEPARTMENT OF
LABOR REGISTRATION
n
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.
Date
Authorized ignature
Department of Labor
Labor Law / Contractor Registration
4 WNEBRASKA
550 South 16th Street, 3rd Floor
DEPARTMENT ENT A Lincoln, NE 68508
NV 'VV VV, 4 op.ne1,ro"dia,go) ( 402) 471 - 2239
Registered Contractors and Subcontractors Locator
Contractor /Subcontractor Name: Skyline General Contracting LLC
Address: 716 Beaver Lake Blvd
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City: Plattsmouth
State: NE
Zip: 68048
Telephone: (402) 235 - 3999
Certificate Number: 43668
Certificate Expiration: 06/15/2015
Contractor Option: 2
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