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Infinity Registration 2014.tif218 S. 16t" Street 131ai1rr NE 68008 (402) 426 4191 Fes.° (402) 426 4195 Email" rjW fblarrgg .bl,Blr.ne.us FOR OFFICE USE ONLY ' Date Paid: � ` ' Rerelpt Na Pam Issutd; , 80N0 0MIR�S: Application Is: !Neva• C7 Renewal CONTRACTOR REGISTRATIONILICENSE RENEWAL me;ase type or print in Ink — IPyoty need more space, please attach additional sheet) Application Is for. W Contractor- $60.00 [1 Electrical Contractor- $ 60.00 [] Water Service Line installer. $60,00 [] Tree Trimmer- $60.00 b Fire/SeeWlty System Cnstaller- $2.5,00 rl Gas Line installer- VS.00 d Mechanlcal Contractor- 560.00 Q Plumbing Contr'actor� $66.00 D Draln flyer- $60,00 Applicant Narnl T-� t tLt-r l 13UslnesxA4dress: _i0,6V<Z _&--foiu) Aden Sao +Clty: State:!UG'_zip: LASJ3� maltAddXoss: �2G.i�ta„,E2s.�, r� My��•M�orc�.ev� Fax 0: _-TfS V , 3 `i 1- 96V'Mobile 0.- BuslnesS Address outside of Nebraska. 11L �)Oo G as e -5 --C, Trig: state - - / _ p` zl . `�701- ?bone: Contact Person-. °� n -- 0 e- 6 N1 �q Number of Employees: fnJ. lvc —0 -'.'Apprentices., _._ Jourrtwmen. Other i,ICensesdieCd: -Ole i 1<5, °t.Gr ryj", P Insurance/Worker's Compensation Compa brAh l L.ayersjElecirlcal, Plumbing and Mechanical Contractom/vitater $"Wee Una Installers need a $6,000 permit Mond try fAvar of the +City of ill.lir. Tree TrItstmm; need a $5,= permit Bund In favor of the ClW of fllalr. Electrical Coritr elmand Hre SeetrrNI Systems installer will ricer(to submita copy of your Nahraske state License. General Corr1ractom need to suttmlt a CeFfMcat a of Insurance whit minimum limits of $ 1,000,000 A99rtiegaW$300,00D each occurrence. All informatlan c,antalned In this applrration is true and correct. I will notify the city Qf Mair of any changes rn the Information reported on or with this application form within T 5 days of the change. 1 hereby malm application to the Licensing guard of Blair, Nebraska Lind certify that I am competent and experienced to ergoQ a In above Said vocatloh. r agree to Confirm Sttictly to the Ordlhmnr es of the City of Blair, Nehraska relative to said voCadori and obey all order, requirements and regulaticns of its lawful constituted authoritkm This certlficatlen alapllcs to the 4riglnal license and/or registration and any renewals thereof, _ Z1 jS h -g Authortzed Stghature Date CITY OF bLAIQ- GENERAL CONTRACTOR REGISTRATION REFERENCES bue to the large number of general contractors seeking roofing and siding work within the zoning jurisdiction of the City of glair, the following reference Information is required. References will be checked, so plea$O ensure reference names and phone numbers are current. NO WORK SHOULD SJDONS PRIOR TO REcEivihlo A GENERAL CONTRACTOR REGISTRATION. Three communities in whloh you are currently registered and have been issued permits: community #1:—C?i"4p,t-fPhone: 11q4j - :51 Community Iornmunity # C?c t6 c-45' ca,,, ­r `t' Phone:t� Community #3 : N-oP foL (c- phone: '40-- V1 q , 90 6 o Three personal references for whom you have recently done work: Cllent#1: QC L,3 -.Phone: o _ -3u 97 t� 6 5 � Client #2:�LA9 J<- A b' Phone: 3.x``9 � /� �3 Client #3: wl X tic +3 t� fy U4 157_ Thane: 44,) ^ �'t© 11 C #a�'n motor/Applicant References verified by: Date Date ;r 218'Saulri 161h 3it t • 5lair, Nebtffss�t dB00� - 402426-41,?l + F*(.402-426.4195 • P.rMll efty4(pl6ir �+6ksk7irnQ,tar MMM 11 -•CRH t` +MUBn8�y3, Uoyq[4itar7tgf,LnUUr �~ `'1�♦' ' r, ,'S �r^���v�,��,(�f;' ,'4:=�,r" r' F �` .r. j !?�1Hr'•Re� �f4lttGn,....1, • 'i ''; ,�' • �•�$b:�t6di'SIh"td�'•.L1I{�Oif{.1`FFti$51�[i�,,. Dat9 (owad 66/41/2014 . ; 7, \ I Dato Fixpirgti i- ,,v• : I'�C4N7kACTt)R 46!01/2015 RAiCPi T ' s IIATION (XRTIP'ICAT'ff F4, Paid: $40.00 hur,ia wtsna(fi. r...(aY. �ILL4I y1 T;t • ,': !['t•:;':.• : 4'; INFINITY ROOPINC, LtC S1DINch-viC.t ;1, ,• ' 18000 CiRMCH2;L PM, til >,i ",�. a; °+ - , :';:: i 1" ;. :i•" i 'r• :. ,`s? ��, HOUSTON, TX 77084 _:":• -' �., ('/�1., t'}1St.`-�i•• a ( . f,'YmmltVirlvni i- ,• `' •tl•• tjn(1.'''urC': .. 11 -•CRH