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The undersigned hereby applies for a Multifamily Rental License as required Uy Title 9, Chapter 908, City Code of the City of Roseville; acknowledges the provisions of Title 9, Chapter 908 have Ueen reviewed; and attests the subject premises will be operated and maivtaived according to the requirements contained therein, subject to applicaUle sanctions and penalties. The undersi��ed agrees that the subject premises may be inspected by the Code Enforcement Officer as provided in TiUe 9, Chapter 908 of the City Code. The applicant furtl�er cei�tifies that all statements and facts in this application are true and authorizes the City of Roseville to investigate any or all statements or facts contained herein acknowledging that the misrepresentation or the omission of fact called for will be just cause for the suspension or revocation of the license. I certify that tl�e above infonnation is tnie and con�ect. I�mdeistand my simlature as property owner and pi•operty manager �vill hold me responsible for the maintenance and management of said rental property, including legal actioii if necessary. I attest I will conduct crimina] back�-ound dlecks on all }�rospective tenants far this property as identified in City Code Section 908.03.B. T attest that all tenant ]eases will contain Disorderly Behavior Lease Provisions as identified in City Code Section 511.02, 908.03C. I attest that a cuirent Occupancy Register will Ue maintained as identified in City Code Section 908.03D. i I attest that if any cllanges occur in any infonnation required on the license application, 1 will submit a new amended license application to the City within 30 calendar days. (i.e. property owner and manager contact name, phone vumbers email, etc.) Some or all of the infonnation that you are asked to provide on the application is classified by State ]aw as either private, public, or confidential. The data will constitute a public record if and when tl�e license is granted. Our purpose aud intended use of this infornlation is to amivally update ow• records and records of other governmental agencies required Uy law. If you refuse to supply the inforn�ation, the license may not be issued. The Undersib ed acknowledges that this application has been read and that the above is correct and a��ees to comply with all the ordinauces and laws of the City of Roseville Citv Code. Print Name of Property Owner: Signature of Property O er: '�``\ Date: � ��.��, �� a� �i��p � s��./ �, bt ,1�� P�i t Name of Lofcal Aaent: �f��s�i(�C ��,,1/� • No License shall Ue assi�able. If any changes occur in ownership, a new license and fee will be required. • If changes in management or local agent occur you must contact our office with the updated infoi7nation. • Rental units may not be occupied without a revtal license. • Your property must have an inspection conducted by a City of Roseville Code Enforcement Officer before a rental license is issued. An inspection time and date will Ue included in the renewal packet. of Lc�a� Date� � '�'f � � �i�,� • License fees are due by June 30, 2015. You will be invoiced far fees following the building inspection and assignment of license tern1. • License fees are non-refundable. • All rental properties are subject to review and may be required to apply and qualify for a different license type based on the level of coinpliance with City Codes and applicable regulations. • The Minnesota Department of Labor and Industry requires completion and submission of a"Certi�cate of Compliance" form proving workers' compensation insurance coverage. Please complete and sign the enclosed form and return with your license application. �Coinpletely filled out Workers' Com�ensation Certificate of Compliance Completely filled out all information iv Sections 1-3. Checked all boxes in Section 5, Property Owner and Local Agent (if applicable) have signed application. � I would prefer fitture con-espondence be mailed. � I would prefer future coi-�-espondence be sent via email. My Email address: FAILURE TO PROVIDE INFORMATION REQUESTED MAY RESULT IN DENIAL OF YOUR APPLICATION Mail or drop off application to: City of Roseville, Community Development Department Rental License Program 2660 Civic Center Drive Roseville, MN 55113