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2. Name of Business*
3. Type of Business (Mech, Elec, Plumb, Roof...etc)*
5. Licensee First Name*
6. Licensee Last Name*
8. Address1*
10. City*
11. State*
12. Zip*
14. Phone Number*
15. Email Address*
17. Business Owner's Name*
19. Please attach copies of driver's license, state license and proof of insurance
21. Upload Files copy of DL*
23. Upload Files State License
25. Upload Files Insurance*
27. License Information & fee

    No license shall become effective until the required certificate of insurance has been submitted and is on file with the city. Roofing Contractors have a $75.00 registration fee.

29. Electronic Signature
    By checking I agree and acknowledge my electronic signature is valid and binding in the same force and effect as a handwritten signature.
31. Check here*

    1. I agree
33. Type Name Here*
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field