Registration Number:
In order to register to do work in the City of Humble, the following information must be provided:
TypeofContractor StateLicenseRequired
□ BuildingContractor/Builder
□ Sub-Contractor
□ Sign Contractor
□ Irrigation Contractor
□ Back-flow Tester
□ Other:
PlumbingContractor
ElectricalContractor
MechanicalContractor
IrrigationInstaller
FireProtection
Other:
Company Name
Business Address: Name
(physical address) TDL#
City, State, Zip:
Mailing Address: Name
(if different from physical) TDL#
City, State, Zip:
Phone: Name
Fax: TDL#
E-Mail:
Signature: Date:
PrintedName: Title:
D.L.# D.O.B.:
□ ApplicationCompleted □ CopyofStateLicense □ CopyofDriversLicense
Approved
□ InsuranceCertificateProvided □ RegistrationFeePaid
By: Date:
BUILDINGDEPARTMENT
05/2020
City of +XPEOH
Contractor Registration Application
:+LJJLQV6W+XPEOH TX 77 Phone: 281--
Office Use
Office Use
1. CompletedContractorRegistrationForm.
2. Proofofcurrent workmen's compensation & comprehensive general liability insurance statingCityof Humble as
thecertificate holder. (not less than $250,000.00 per occurrence for bodily injury and $100,000.00 per occurrence
for property damage)
3. CopyofStateissuedMastersorequivalentLicense(whenapplicable).
4. CopyofstateissuedDriversLicense.
5. $100registrationfeeforcontractor(Company/Person/License Holder) **Registration Valid For One Calendar
Year. (Jan 1st thru Dec 31st) Must renew Annually**
Eachoftheseitemsmustbeprovided IN PERSON, by the License Holder if applicable without exception, approved,
and entered into our records before any work may bepermittedor commencedintheCityofHumble. (The
license holder MUST register the Company)
Persons Authorized to Obtain
Permits in the Company Name:
Theinformationsubmittedforthiscontractor'sregistrationistrueandaccuratetothebestofmyknowledge.IUnderstandthatpermitsare
requiredtobeissuedpriortocommencementofanyandallconstructionwork,andthatperiodicinspectionsmustberequestedforbymyselfor
mystaff,tobeperformedbytheBuildingDepartment,particularlypriortoperforminganyworkthatwillcoverorobscurepreviouswork,and
thatpermissiontocoverworkwillalwaysbegiveninwriting.Thecityreservestherighttoholdordenypermitstocontractorswhofailto
completeandobtainfinalsforeachpermitissuedundertheirregistration.Furtherthecitymayfineorsuspendtheregistrationofanycontractor
whofailstocomplywithapplicablecity,state,orfederalcodesandregulations.IfCitationsareissuedforviolations,thecityisobligatedto
contactanyapplicablelicensingboard.
License#
C-101
click to sign
signature
click to edit
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