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                                                  CONTRACTOR REGISTRATION This document has been designed  
     Print               Clear                                    City of Muskegon                                        to complete online, print, SIGN,  
                                                              933 Terrace St. P. O. Box 536                                  and mail to the city with all  
                                                                 Muskegon, MI 49443-0536                                 associated fees.  This form IS NOT  
                                                                                                                             designed to be submitted  
                                                                     Phone 231-724-6758                                             electronically.

Contractor License #                                                              Expiration Date


Building                                   Electrical                                   Plumbing                                   Mechanical

                                                          Sign                                         Alarm

Contractor: (Contractor Name must be the same as shown on License)


Address:


City:                                                              State:                   Zip Code:
                                                                     MI
Contact  Person:                                                                            Phone:


Federal ID #: or reason for exemption                                                       Date of Birth:


State Employer ID #: or reason for exemption


Workers Compensation Insurance #: or reason for exemption


Liability Insurance Carrier: required for sign contractors

Contractor Signature:                                                                                           Date:



Instructions:
All contractors must register with the City of Muskegon before applying for Building, Plumbing, Mechanical or Electrical permits.

Residential Builders, Electrical Contractors, Mechanical Contractors, Plumbing Contractors, Sign Contractors, and
Alarm Contractors must submit a copy of your current license with this registration form.


Registration Fee:
                           Electrical: $15.00                   Plumbing: $15.00                           Mechanical: $15.00

                           Sign :        $15.00                   Alarm:       $15.00                            Building:      $15.00





                                                                                                                                                   CR1 /0 4