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2. Instructions

   Please note that all  fields are REQUIRED to be completed before you can submit your application.

   You can save your progress without submitting and come back to it later to complete.

4. Is this a new registration or a renewal?

   1. New Registration

   1. Renewal
6. License Type*

   For what type of license are you applying?

   1. Mechanical Contractor

   1. Electrical Contractor

   1. Plumbing Contractor
8. First Name, Last Name*
9. Company Name (Doing Business As)*
11. Street Number*
12. Street Name*
13. Apt/Ste #
15. City*
16. State*
17. Zip*
19. Email Address*
20. Phone Number*
22. Copy of Driver's License*
23. Copy of Trade License*
25. Copy of Liability Insurance*

    You must submit a copy of your liability insurance in the amount of $500,000 with the City of Anna listed as the certificate holder.

Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field