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2. DEPT. OF BUSINESS &  

   PROFESSIONAL REGULATION (DBPR) LICENSED CONTRACTOR 

   REGISTRATION

3. CITY OF KEY WEST

   BUILDING DEPARTMENT

   P.O. BOX 1409

   KEY WEST, FL  33040

7. Per Florida Statute 489.119(5)(c) 

   If a vehicle bears the name of a contractor or business organization, or any text or artwork which would lead a reasonable person to believe that the vehicle is used for contracting, the registration or certification number of the contractor must be conspicuously and legibly displayed with the name, text, or artwork. Local governments may also require that locally licensed contractors must also display their certificate of competency or license numbers. Nothing in this paragraph shall be construed to create a mandatory vehicle signage requirement.

9. Date:*
   Date:
11. Business Name:*
13. Qualifier Name:*
15. Business Address:*
17. City*
18. State*
19. Zip Code*
21. Business Phone Number:*
22. Mobile Number:*
24. E-mail: *
26. Select which applies:*

    1. Air Conditioning
    2. Alarm Systems
    3. Asbestos
    4. Building
    5. Electrical

    1. Electrical Speciality
    2. Elevator
    3. General Contractor
    4. Mechanical
    5. Mold Remdiator

    1. Plumbing
    2. Pollutant Storage
    3. Pool / Spa
    4. Residential
    5. Roofing

    1. Sheet Metal
    2. Solar
    3. Utility / Excavate
    4. Speciality
28. Attached either Workers' Comp (WC) Insurance or WC Exemption:*
29. Attach Copies of Business Tax Receipts from Local Jurisdiction: *
30. Attach Copies of Liability Insurance:*
31. Attach Copies of DBPR State License *
33. Electronic Signature*

    By checking "I agree", you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.

    1. I agree
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

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