2. Contractor Registration Form*

   1. Contractor Building
   2. Master Electrician
   3. Electrician
   4. Master Mechanical
   5. Mechanical
   6. Master Plumber

   1. Plumber
   2. Master Sign Electrician
   3. Backflow (Special Form)
   4. Fire Line Tester
   5. Irrigation
   6. Other

4. Contractor Information

6. Company Name*
7. Contractor Type*
9. Primary Contact Name*
10. Officer Phone #*
12. Contact Cell Phone #*
13. E-mail*
15. Fax
16. Address*
18. City*
19. Zip Code*

23. Contractor Insurance Information

25. Provider Name*
26. Provider Phone #*
28. Policy Number*

32. Master Information

34. Master Name*
35. Master License*
37. Master Cell Phone #*
38. License Expiration*
    License Expiration

42. Journeyman Information

44. Journeyman Name
45. Journeyman License
47. Journeyman Cell Phone #
48. License Expiration
    License Expiration
52. Signature*
53. Date*
    Date
55. You Must Email the following:
    • Driver's license
    • Insurance
    • State license

    Email to: buildingpermits@cockrell-hill.tx.us

    
    

Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

* indicates a required field