Contractor License Application

Business Name

Contact Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Certificate of Insurance

Max. file size: 128 MB.

NOTE: Certificate of Insurance for Contractor’s general liability and Workers’ Comp must list the Town of Timnath as the holder.

Type of work to be performed (select all that apply):(Required)

General Contractor

Electrical (includes PV)

Roofing

Plumbing

Heating/Air

Landscaping

Concrete/Asphalt

Mechanical

Other

Copy of Master State License (for Electricians and Plumbers ONLY)

Max. file size: 128 MB.

State License REQUIRED for Electricians and Plumbers

Copy of ID for Master License Holder

Max. file size: 128 MB.

REQUIRED for Electricians and Plumbers only

Notarized Lawful Presence Affidavit (if required)

Max. file size: 128 MB.

IF YOU ARE THE SOLE PROPRIETOR (not Inc. or LLC) of your business, you must now comply with the requirements of House Bill 06S-1023. If you have not done so in a previous year, you must: Complete the Lawful Presence Affidavit . Sign the Affidavit before a notary Public (A notary is available at Town Hall.) Return the Affidavit with your signed contract, application or renewal. Enclose a copy of the identification presented to the Notary (e.g. driver’s license)

Fees to be Included with Application (select one):

$100.00 Fee (one year license)

$25.00 Fee (one-stop for 1 job address / 180 days)

No Fee for State Licensed Plumbers or Electricians

One-Stop License address of work to be done:

Signature

Contractor hereby agrees that he is responsible for all work performed according to drawings and specifications filed and approved by the Town of Timnath. Each contractor for a specific job will have their own current contractor’s license prior to permit issuance.

Name

First Last

Date

Name

This field is for validation purposes and should be left unchanged.