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City of Roseville <br /> Finance Department, License Division <br /> 2660 Civic Center Drive, Roseville, MN 55113 <br /> (612) 490-2212 <br /> Recycling Contractor License A pp lication <br /> 1 <br /> 03 <br /> Fee Due: 5125.001 Year l <br /> (License\%-ill be Icr January i to December l <br /> Vrem <br /> Business Name [j <br /> j _�[2 <br /> .3 E� <br /> Business Address ?.I- <br /> 3 <br /> Contact Person �' <br /> w ,„"'"°�°b° .wL...,.._yam•Y =' <br /> .....�.+►■r.wvi},:,wyxrr,.. k;k n• �w ! ■ .. -►7 �� /■■. �'►�i1�� <br /> If completed license should he mailE s��m titi/#terc utt er rn i t�� a� r� -•-~:� � � •--� <br /> Recycling services \\-ill be provided to (check all that tzi p p l\-)= <br /> Residential _ _ ("miniercial <br /> M u l t i f any ik: Industrial <br /> Number ofvehicles the applicant proposes to use in the collection o f re c\-c fables <br /> Name and address of companies where recy c lables will he marketed: <br /> z z <br /> — - Ji <br /> f'[l111C' C'rrrr11kct[c.(1 C.clr'[1/7(j n/ 01110' (I)ICUNC APLVI� t_1 <br /> r � r <br /> I have been provided with a copy of the City of Roseville Curbside Recycling Ordinance (available at <br /> xiv-":N v.ci.roseville.mn.usladm"inlcitycodelch4o3.txt) and understand that violation of any of the provisions <br /> included in the ordinance map result in suspension or revocation of the license. <br /> I have attached a certificate of liability/ insurance. a e ificate indicating. Worker Compensation co%'eratic. <br /> and the fee of$125.00. <br /> Applicant's Signature <br /> 4 <br /> Date <br />