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CITY OF CODY GENERAL CONTRACTOR LICENSE APPLICATION Applicant’s Name (Qualifier): Business Name: Physical Address: City: State: Zip: Mailing Address: City: State: Zip: Phone: Cell: Email: Before completing the section below, please read the contractor licensing regulations, found in Title 9, Chapter 3 of the City of Cody Code (attached and/or available online at: www.cityofcody-wy.gov/111/Municipal-Code Category of License Requested: □ General Contractor (Authorized to perform work on all components of commercial and residential structures except those components requiring an electrical license, plumbing license, or mechanical/HVAC license.) Attach certification showing you have passed the International Code Council National Standard Exam for Class Commercial, or Class Commercial and Residential contracting. □ General Contactor—IRC (Authorized to perform work on all components of a residential structure that is subject to the International Residential Code, except those components requiring an electrical license, plumbing license, or mechanical/HVAC license.) Attach certification showing you have passed the International Code Council Class Residential Contractor Exam. Work History: Provide a resumé of your personal work history demonstrating that you have the minimum relevant experience required (60 months for General Contractor category/ 24 months for General Contractor- IRC category). Include contact information for your employer(s) or the building official(s) where the work was performed. You may use the attached “Work History” form if you do not have a resumé with the information requested. Insurance: Provide an insurance certificate from your insurance company indicating that your company has liability insurance in the amounts noted below, and which insurance certificate lists the City of Cody as a “certificate holder” (not “additional insured”). □ Bodily injury liability insurance coverage of not less than one million dollars per person/occurrence; and, □ Property damage liability insurance coverage of not less than one million dollars for each occurrence. Fee: The application must be accompanied by the $150.00 application fee. Payment may be made to the City of Cody by cash, check, or credit card (Visa, MasterCard, Discover). (Over) STAFF USE Invoice: Date Submitted: Previously Licensed? Y/N ---PAGE BREAK--- Certification: By signing this application form, I certify that: 1) I have read and understand the City of Cody Contractor Licensing Ordinance (Title 9, Chapter 3 of the City of Cody code) and agree to comply with the requirements thereof; 2) The information contained in this contractor license application and associated documents submitted herewith is true and accurate; and, 3) I understand that failure by me, or my employees while under my supervision, to comply with the requirements of the City of Cody Contractor Licensing Ordinance, including failure to obtain all required permits and inspections, is grounds for suspension and revocation of my contractor license. Signed this day of , 20 . Name of Business: By: Title/Office: STATE OF WYOMING ) ) COUNTY OF PARK ) The foregoing instrument was acknowledged before me by this day of , 20 . Witness my hand and official seal. Notary Public My Commission Expires: Contractor Licensing Board Review: Review of this application includes an interview by the Building Official and/or Contractor Licensing Board. If Board review is required, they typically meet the 4th Thursday of each month at noon in the City Hall conference room (1338 Rumsey Avenue). Applications requiring Board review should be submitted at least ten days prior to the meeting. You may schedule an interview with the Building Official by calling (307) 527-3469, or emailing either Sean Collier at [EMAIL REDACTED] or Bernie Butler at [EMAIL REDACTED]