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Contractor Registration
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W10=
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Date
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Company name
*
Street address
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City
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State
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Zip Code
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Phone
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Email
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Licensee name
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State license number
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Registration type
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Registration type
Building residential = $20
Mechanical = $15
Electrical = $20
Plumbing = $1
Building commercial: $20
Fence: $20
Sign: $20
Right of way: $20
Shed: $20
Fire suppression: $20
Fire alarm: $15
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Electronic signature
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Type your full name to confirm:
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Upload supporting documents
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Attach copy of driver's license and contractor license
Submit
Submit Form
/frontend_forms/resumable_upload/
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