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2. You must provide all requested information on the application. Blanks will delay the processing of the application and issuance of the license.

4. Date
5. Business Owner's Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
16. Fax Number
18. Business Name
19. Business Email
21. Address
23. City
24. State
25. Zip Code
27. General Builder / Commercial

    1. Annual Fee $250
    2. Mid Year Fee $125 June 30 to December 31
28. General Contractor / Residential

    1. Annual Fee $100
    2. Mid-Year Fee $50 June 30 to December 31
30. Sub-Contractor Specialty

    1. Annual Fee $100
    2. Mid-Year Fee $50 June 30 to December 31
32. Specialty

    1. Asphalt
    2. Carport
    3. Concrete
    4. Demolition
    5. Excavation
    6. Fence
    7. Fire Protection
    8. Handyman
    9. Heating and Air/Mechanical
    10. House Moving
    11. Landscaping
    12. Lawn Care
    13. Masonry
    14. Painting
    15. Roofing
    16. Siding
    17. Sign
    18. Swimming Pool
    19. Tree Trimming
    20. on Construction Such as Carpet Cleaning, Pest Control, Commercial Office Cleaning, Parking Lot Sweeping, etc.
    21. Other
34. Please Describe*

36. A Certificate of Insurance must be filed with the City certifying public liability insurance in the amount as provided by Missouri State Statutes. Applicant must also file a certificate of insurance for worker's compensation coverage or an affidavit*, the form of which shall be developed by the Division of Labor and Industrial Relations for the State of Missouri, signed by the applicant attesting that the contractor is exempt. (Sec. 12-149). All certificates must list the City of Carthage as the Certificate Holder. Missouri employers involved in the construction industry are required to carry worker's compensation coverage if they have one or more employees. Note Affidavit must be notarized.

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

    This field is not part of the form submission.

40. Submit

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