Project Name:______________________________
Project Address:____________________________
City of Round Rock Texas
Contractor Information Sheet
Company Name:
Contact Person:
Title: Phone Number:
Mobile: Email:
Office Address:
City: State: Zip:
Phone: Fax:
Please Select One
Contractor Type: General Plumbing Mechanical Electrical Irrigator
License Holder’s Name:
License Number: Expiration Date:
dd/mm/yyyy
Electrical Contractor License Number:
dd/mm/yyyy
FORM MUST BE SIGNED BY LICENSE HOLDER
Signed:
Printed Name:
Forward To:
Building Inspection Department
Attn: Isabella Morales
Email: BuildingPermits@RoundRockTexas.gov
Expiration Date: