Engineer's Registration Application 06-2016-TD06-2016 TD
DESIGN ENGINEER REGISTRATION APPLICATION
Approved By: ________________
Division Staff
Date: ________________________
Division Staff
License Number: ______________
Division Staff
No fee required at this time for Engineer’s Registration.
1.Company Name: ___________________________________________________________________________________
Address: ________________________________________________________________________________
City: ___________________________________________ State: _______________ Zip: ______________________
Business Phone: _______________________________ Business Fax: _____________________________________
Email: ______________________________________________
2.Responsible Individual: _____________________________________________________________________________
Address: __________________________________________________________________________________________
City: ____________________________________ State: _______________ Zip: _________________________
Phone: _____________________________________ Fax: ____________________ Cell Phone:___________________
Driver’s License Verified: Yes No _______ (Staff initials)
3.State Board of Engineer’s License No: ______________________________ Expiration Date: ___________________
If there are multiple engineers with the company that wish to register; please provide information for each requested in
items 2 and 3 and use a second page.
Registration of Design Engineer’s is required by City Ordinance 13-C-08 before performing any design work or
conducting on-site inspections at project sites. All regulations adopted by Ordinance 13-C-08 shall be complied with.
Registration must be renewed annually within 30 days of expiration.
4.I certify that the statements made in answer to the foregoing questions are true and correct to the best of my
knowledge and belief.
Print Name: _______________________________________________
Signature: _________________________________________________ Date: ___________________________________
PLANNING & COMMUNITY DEVELOPMENT INSPECTIONS DIVISION 1400 SCHERTZ PARKWAY, BLDG. #1
SCHERTZ, TEXAS 78154-1634 (210)619-1750, FAX (210) 619-1769
Email: inspections@schertz.com