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Contractor-License-Application-PDF Date of Application: __________

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  • 62 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Jackson, Wyoming

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Town of Jackson
Contractor License Application
PO Box 1687, Jackson, Wyoming 83001
Phone: (307) 733-0520
Fax: (307) 734-3563
www.townofjackson.com
Instructions: All information on both sides of this form must be fully completed. Failure to complete any item will delay the processing
of your application. All payments shall be made at the time of application and shall be non-refundable.
An application for a
contractor’s license must be submitted and approved by the Town Building Department before the business can begin
operations.
Please Check One
New Application Renewal Updated Information Contractor’s License # :_________
Business Name: ______________________________________________________________________
Is the Business a: Corporation Partnership Sole Proprietorship
Other Please explain: ________________________________________________________________
Contractor Classification Applied for: _____________________________________________________
Master of Record ________________________Address_______________________________________
Master Certificate of Qualification Number_________________________________________________
List Information for all Owners/Officers/Partners
Name/Title Address Date of Birth Phone Number Email
Business Physical Address: Street & No:_____________________________________
Bldg/Apt:__________ City:_________________ State:_______ Zip Code___________
Business Mailing Address:
Post Office Box:____________ City:________________ State:_____ Zip Code:______
Business Phone Number: (____)____________________________
Fax/email address: ______________________________________
Federal Employers ID Number_____________________________
WY Sales Tax Number___________________________________
Number of Employees____________________________________
Provide the following, if applicable, with this application:
Proof of Unemployment Insurance
Proof of Workman’s Compensation
Proof of Surety Bond
Proof of Liability Insurance
If a corporation or LLC, proof of good standing with the State of Wyoming
Electrical Contractors must provide a copy of their State of Wyoming Master and Contractor licenses
Have you ever been convicted of a felony? ____Yes ____No
Have you ever had a construction related license suspended or revoked?
____Yes____No If yes, explain.____________________________________________________
Have you ever had a construction related license in another jurisdiction?
____Yes____No If yes, provide name of jurisdiction.__________________________________
* The above information MUST be provided in order for your application to be processed.
(over)
Business is A Sales Tax Collecting Business A Non-Sales Tax Collecting Business
IF THE BUSINESS LOCATION IS WITHIN THE CORPORATE LIMITS OF THE TOWN OF JACKSON COMPLETE THE
FOLLOWING SECTION
Is the Business in your residence? Yes No
If Premise was previously occupied, was it a Residence Business
If Business, What type: _________________________________________________________
Are you installing, or is there an existing Alarm System in the building? Yes No
** If you answered “Yes” to the above question, you MUST post a bond with the Jackson Police Department.
If property is rented/leased:
Name of the Owner____________________________________________________
Owner’s Mailing Address_______________________________________________
** Any change of business location requires a new application and approval by the Town of Jackson
.
Owner’s Phone Number________________________________________________
Where is the parking provided for your business? _____________________________________________________________________
How many spaces are allocated to the business? ____________________________
Square Footage of business location_______________________________________
Does the building have a fire-sprinkler system?______________________________
Will you be posting a sign for your business? Yes No
__________________________________________________________________________________________
I, as applicant, hereby certify that the State of ___________________
statements in this application are true County of__________________
and correct to the best of my knowledge On________,20__,__________
and belief. I understand that false personally appeared before me,
statements or willful omission of pertinent whose identity I proved on the
information will be grounds for denial basis of___________________
or revocation of a license to be the signer of this instrument
and he/she signed it.
Date: ___________________________ _________________________
Signed: __________________________ Notary Public
My commission expires______
For Official Use Only – Please Do Not Write Below This Line
___________________________________________________________________________________________________________
Business is: Home Occupation Home Business Other
Zoning : UC UC2 UR AR AC SR R
BC NC NC2 OP RB BP MHP
Business Physical Location: Within the Town Limits In Teton County Out of Teton County
Approving Department Initials Date Approved
Comments
Building Department
Fire Department
Planning Department
Police Department
Application Approved
Application Denied; reason: _________________________________________________________
______________________________________________________________________________________
License Fee $
Prorated Fee $
Date Paid
Receipt Number
Employee initials
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Completed 13 July 2020

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