2. 
3. City of Ponca City

   Development Services Department
   516 E. Grand
   PO Box 1450
   Ponca City, OK 74602
   Phone 580-767-0383
   Fax 580-767-0325

5. License Registration Form-Residential Contractor

7. Date
9. Applicant's Name*
10. Phone #*
11. State*
13. Applicant's Address*
14. City*
15. Zip*
17. Business Name
18. City
19. State
20. Zip
22. Email Address*
24. A License Will Not Be Issued Until The Following Is Received
    • Current copy of Driver’s License
    • Current copy of Certificate of Liability Insurance, meeting all current ordinance requirements
    • Current copy of the Worker’s Compensation Act Affidavit of Exempt Status (notarized) *Needed only if not carried on liability insurance policy
26. Registration Fee Schedule

    (A) FOR CONTRACTORS:

    1. For the first year or portion thereof: three hundred dollars ($300)
    2. Subsequent renewals: seventy-five dollars ($75)

    IF A CONTRACTOR HAS NOT RENEWED HIS OR HER REGISTRATION CERTIFICATE BY JULY 31, THE FEE SHALL BE THE SAME AS THE FEE REQUIRED FOR THE FIRST YEAR. INDIVIDUALS NOT RENEWED BY THIS DATE WILL NOT BE ALLOWED TO CONTINUE WORK WITHIN THE CITY OF PONCA CITY JURISDICTION.

28. I HEREBY CERTIFY THAT ALL OF THE ABOVE STATEMENTS ARE TRUE AND CORRECT.
30. Date:
31. Signature of Applicant
33. $
34. By
36. Amount Collected $
37. Date:
39. Expiration Date:

41. IF MAILING, PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO CITY OF PONCA CITY AND MAIL TO: DEVELOPMENT SERVICES DEPARTMENT, P.O. BOX 1450 PONCA CITY, OK, 74602. DO NOT MAIL CASH.

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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