Commercial Contractors Registration Form - City Of Walker

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CITY OF WALKER
4243 REMEMBRANCE RD NW
WALKER, MI 49534
PHONE# (616) 791-6858 FAX # (616) 791-6881
COMMERCIAL CONTRACTORS REGISTRATION FORM
BUSINESS NAME___________________________________________
BUSINESS ADDRESS ________________________________________
CITY __________________STATE _______________ ZIP CODE_________
BUSINESS PHONE (
) ________________ FAX (
) _____________
CELL PHONE (
) ____________________
PERSON(S) AUTHORIZED TO SIGN FOR PERMIT:
PRIMARY AUTHORIZATION:
_____________________________________________________________
PERSONS AUTHORIZED TO PULL PERMITS UNDER LICENSEE:
________________________________ ________________________
_______________________________
________________________
REGISTRATION FEE: 15.00
RECEIPT NO. ___________________DATE: _______________________

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