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2. Application For:*

   1. New

   1. Renewal

   1. Bond Expiration

   License Fee: $75 per year
3. License Number
   (If Renewal is selected, please fill in your existing license number here.)
5. Licensing For:*

   1. Concrete Contractor License (Bonding Required)
   2. Electrical License
   3. Fencing Contractor License
   4. Landscape / Tree Care Contractor License
   5. Mechanical License
   6. Plumbing / Mechanical License

   1. Plumbing / Sprinkler License
   2. Roofing Contractor License
   3. Roofing / Siding Contractor License
   4. Siding Contractor License
   5. Sign Contractor License
   6. Other

   Select one or more, as applicable.
7. Copy of current City of Wichita or Sedgwick County Master License*
8. 
   Copy of Proof of Insurance*
9. Copy of current State of Kansas Roofing Contractor Registration Certificate
   (If applying for a Roofing License.)
13. Business Name*
14. Email Address
16. Business Address*
18. City*
19. State*
20. Zip Code*
22. Phone Number*
23. Fax Number
27. Business Conducted As:*

    1. Individual

    1. Partnership

    1. Corporation
29. Personnel of Business
31. Name
32. Office or Position
34. Name
35. Office or Position
37. Name
38. Office or Position
42. Person(s) Authorized to Obtain Permits and Request Inspections:
44. Name
45. Office or Position
47. Name
48. Office or Position
50. Name
51. Office or Position
55. Are there any liens, suits, or judgments now pending against you or the business party?*

    1. Yes

    1. No
56. Have you or the organization filed for bankruptcy during the past year?*

    1. Yes

    1. No
58. Who is financially responsible for the business?*
60. Please indicate if you would like to include your company on the Bel Aire website list of licensed contractors. No additional charge.

    1. Yes

    1. No
64. Statement of Agreement
    In submitting this application, it is understood that the applicant whose electronic signature appears below agrees to comply with the provisions of the codes, ordinances, and resolutions applicable and that it is unlawful for a licensee to allow his or her name or license to be used by another, and farther that a license may be revoked for reason of misrepresentation of facts in obtaining such a license.
66. Name*
    (Electronic Signature)
67. Date*
    Date
71. Will you mail your payment to City Hall?

    1. Yes
    2. No

    
    The application's payment by check or money order for the license is to be submitted to:
    City of Bel Aire
    Department of Community Development
    7651 E Central Park Avenue
    Bel Aire, KS 67226
    
72. Would you like to pay over the phone?

    1. Yes
    2. No

    ***Once the application has been reviewed and processed, you will receive a phone call for payment.
Leave This Blank:


78. 1. Receive an email copy of this form.
79. Email address

    This field is not part of the form submission.

80. Submit

* indicates a required field