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2. INSTRUCTIONS:
   *Fill out the application completely and mail a check to Lawrence County Planning & Zoning, made payable to Lawrence County Treasurer to 90 Sherman Street, Deadwood, SD 57732 and please note it is for a Contractors License.
   
   *Pay fees: Make checks payable to Lawrence County Treasurer’s Office (all returned checks have a $40 fee)
   
   *Provide a Certificate of Insurance showing Lawrence County as a Certificate Holder ($1,000,000 each occurrence liability insurance AND $2,000,000 general aggregate liability insurance) If you have employees you will also be required to show proof of Worker’s Comp Insurance.
   
   
4. THINGS TO REMEMBER:
   *You must have a license to operate in Lawrence County.
   
   *All licenses terminate on December 31 of the year for which it was issued. You must reapply every year.
   
   *Licenses may be revoked by the Commissioners for violations.
   
   *No building permits shall be issued unless proof has been given that the contractor is licensed in Lawrence County.
8. CONTRACTOR INFORMATION:
10. Business Name*
11. Contractor Name*
13. Address*
15. City*
16. State*
17. Zip*
19. Phone*
20. Email*
22. SD Excise Tax #*
    **All contractors working in South Dakota are required to have a contractor's excise tax permit. AR 64:09:01
23. Upload Certificate of Liability Insurance
24. License Type*
    -- Select One --CarpentersConcreteElectricalExcavatorsGeneral ContractorMechanicalPlumbing
26. Acknowledgement
    The digital signature below certifies that the person signing is going to follow 2018 International Building Codes as adopted by Lawrence County as of May 21, 2019.
28. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature
31. Date*
    Date
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field