Forms • McCook, NE • CivicEngage

New license

Renewal License

*Registration expires December 31st of each calendar year.

Company name:
(Must match name and address on Certificate of Insurance)*

Mailing Address:*

City/State/Zip:*

Physical Address:

City/State/Zip:

Phone:
*

Primary Contact?

Yes

No

Cell Phone:

Primary contact?

Yes

No

Email:

Liability Insurance Carrier:

Expiration:

YOU MUST PROVIDE A COPY OF YOUR LIABILITY INSURANCE WHEN APPLYING FOR YOUR LICENSE.

**The City of McCook must be listed as a Certificate Holder of liability insurance, including projects and completed operations for three hundred thousand ($1,000,000) dollars or more per occurance, per license type.
**If for any reason your Insurance is not current or has expired, your license with the City of McCook will be revoked.

Adopted Model Codes (2018)

IBC, IRC, IPC, IMC, IFGC, IEBC, IECC

Applicant's Statement

I acknowledge that this application will be considered by the Building Inspector and the Building and Housing Code Advisory and Appeals Board (if necessary) and I certify that the information contained herein is true and accurate to the best of my knowledge. I agree to comply with all City ordinances and codes and to hold the City harmless of any damages that may arise from faulty performance or neglect of duty on my part.

Electronic Signature*

Date:

** Please choose the type of license in which you are applying.
** Add names in the appropriate categories (If applicable).

BUILDING CONTRACTOR LICENSE ($75)

GENERAL CONTRACTOR

BUILDING CONTRACTOR

RESIDENTIAL CONTRACTOR

Renewal ($25)

Name:

CEU's/Test Score

Name:

CEU's/Test Score

SKILLED TRADE LICENSE ($75)

PLUMBING (MASTER)

PLUMBING (JOURNEYMAN)

PLUMBING (APPRENTICE)

MECHANICAL (MASTER)

MECHANICAL (JOURNEYMAN)

MECHANICAL (APPRENTICE)

Renewal ($25)

Name:

CEU's/Test Score

Name:

CEU's/Test Score

LIMITED CONTRACTOR LICENSE ($75)

CONCRETE

DEMOLITION

EXCAVATION

FENCING

ROOFING

STRUCTURE MOVING

Renewal ($25)

Name:

CEU's/Test Score

NUMBER OF YEARS ENGAGED IN SUCH WORK:

(See Contractor's License Fees and Requirements sheet for additional information)

QUALIFICATIONS-List education, training, experience and any jurisdictions you have been licensed. (Attach extra sheet(s) if necessary)

* indicates required fields.

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