CONTRACTOR REGISTRATION FORM

Select Registration Type:

Utility Contractor/Subcontractor (includes concrete work in ROW) (No Fee) Irrigator (No Fee) Mechanical Heat and Air Conditioning ($110/Annual) Energy Inspector (provide HERS Rater Certification) ($110/Annual) Electrical/Electrical Sign Contractor (No Fee) Plumber (No Fee) Rental Manager ($110/Annual) General Contractor* ($110/Annual)

* Includes but not limited to Home Builder, Roofer, Concrete Contractor (private property), Pool Contractor, Fencing Contractor, Solar Contractor & Sign Contractor

Applicant must sign and attach a copy of their current Texas Driver’s License AND a copy of the Texas State License if registration
is for a licensed trade (i.e. Plumbing, Electrical, HVAC, Irrigation, or Energy Inspector). Please note, the MASTER license is required
for Plumbing & Electrical registrations. For General Contractors, an Officer or Owner of the company (President, Vice President or
CEO) must sign and provide a copy of their Texas Driver’s License. A Certificate of Insurance is required for Utility Contractors.

Business Name *

License Holder/Officer/Owner Name: *

Title: *

Email *

example@example.com

State License Number#: *

State License Expiration *

Date

Business Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Office Number

Please enter a valid phone number.

Cell Number

Please enter a valid phone number.

Person Authorized to obtain a permit under this company name:

First Name Last Name

Additional?

Please submit a copy of your licenses, insurance or other supporting documents:

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Person Authorized to obtain a permit under this company name:

First Name Last Name

The undersigned person will be held responsible for seeing that all work being performed under this registration is completed and is in compliance with the building codes and City ordinances.

REGISTRATION FEES ARE CHARGED PER LICENSE/REGISTRATION BEING REGISTERED FOR THE AMOUNT INDICATED ABOVE. RENEWAL NOTICES WILL BE EMAILED ONLY IF AN EMAIL ADDRESS IS PROVIDED. NO OTHER NOTICES WILL BE
PROVIDED.

Name of Submitter

First Name Last Name

Signature

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