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Electrician/Plumber Contractor Registration

Business Or Service type
Business Name
Address
Phone
Email
Confirm Email
Website
State-issued License Holder
State-issued License Number
Emergency Contact
Emergency Contact Email
Confirm Emergency Contact Email
24-Hour Phone

With this submittal I certify that:

•I currently possess the State required minimum Liability Insurance

•All trash will be removed from on-site and will be properly disposed of

•I must renew annually or before my state issued license expires, which comes first

•All information on this application is true and correct

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