Contractor Registration
Application
Contractor Type:
Registration Type:
General
Pool
Irrigation
(Circle One)
New Renewal
Mechanical
Concrete
Backflow
Electrical
Fence
Fire Alarm
Plumbing
Roofing
Fire Sprinkler
Propane
Utility
Sign
Architect
Contractor Information
***If a license holder exists, you must use that person’s information. License holder is the person who
holds the State License. This person will be held responsible for seeing that all work being performed
follows the State codes, City codes, and ordinances***
This application must be signed at the bottom by the Owner/License Holder listed below!!!!
Company Name:
Owner/License Holder Name:
Address:
City/State/Zip
Fax:
Cell:
Email:
Personnel authorized to obtain a permit under this registration: (use company letterhead for additional names)
Name:
Phone:
Name:
Phone:
Name:
Phone:
Name:
Phone:
Name:
Phone:
Name:
Phone:
COLOR COPIES OF CONTRACTOR’S DRIVERS LICENSE
AND TRADE LICENSE ARE REQUIRED
Signature of Applicant
Printed Name of Applicant
Date:
click to sign
signature
click to edit