Fillable BUILDINGCONTRACTOR REGISTRATION THE SECTION BELOW MUST BE FILLED (City of West University Place)

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BUILDINGCONTRACTOR REGISTRATION THE SECTION BELOW MUST BE FILLED (City of West University Place)

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BROWSE CITY OF WEST UNIVERSITY PLACE (TX) FORMS

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3826 AMHERST ST. WEST UNIVERSITY PLACE, TX 77005 | 713.662.5833 | INSPECTIONS@WESTUTX.GOV
PAGE 1 OF 1
Public Works Department
Development Services
INSPECTION REQUEST LINE 713.662.5805 | BEFORE 4:30 PM FOR NEXT DAY
BUILDING–CONTRACTOR REGISTRATION
COMPANY INFORMATION
COMPANY NAME FEDERAL TAX ID NUMBER
MAILING ADDRESS
PHONE NUMBER
EMAIL
LICENSE INFORMATION
LICENSE HOLDER FIRST NAME LAST NAME
STATE LICENSE NUMBER EXPIRATION DATE
TYPE OF CONTRACTOR
GENERAL LIABILITY INSURANCE
All contractors performing work in the City of West University
place are required to carry General Liability Insurance with
limits of $300,000 or limits required by your state license.
We require proof of insurance in the form of a Certicate of
Insurance. The form must name the City as the certicate holder.
You may have your insurance company fax a copy or email to
inspections@westutx.gov
OWNERSHIP
TYPE OF OWNERSHIP
CORPORATION PARTNERSHIP SOLE PROPRIETOR OTHER
A corporation requires all three elds to be lled out:
President, Vice-President & Secretary.
A partnership requires all partners to be listed—attach an
additional sheet if necessary.
APPLICANT SIGNATURE DATE
PRINT NAME
OWNER/OFFICER 1
TITLE
FIRST NAME
LAST NAME
DOB DRIVER LICENSE
NUMBER
PHONE NUMBER
ADDRESS
OWNER/OFFICER 2
TITLE
FIRST NAME
LAST NAME
DOB DRIVER LICENSE
NUMBER
PHONE NUMBER
ADDRESS
OWNER/OFFICER 3
TITLE
FIRST NAME
LAST NAME
DOB DRIVER LICENSE
NUMBER
PHONE NUMBER
ADDRESS
OFFICE USE ONLY
EMPLOYEE INITIALS
DATE PAID
CONTRACTOR ID
MUST PROVIDE COPY OF EACH OWNER(S), CORPORATE
OFFICER(S) OR PARTNER(S) DRIVER'S LICENSE AND
THE STATE LICENSE HOLDER(S) DRIVER'S LICENSE AND
STATE LICENSE (IF APPLICABLE).
CONTRACTOR REGISTRATION
THE SECTION BELOW MUST BE FILLED OUT
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BUILDINGCONTRACTOR REGISTRATION THE SECTION BELOW MUST BE FILLED (City of West University Place)

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Completed 17 July 2020

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