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�� : �� - -�r <br />� <br />Ci�y of Roseville <br />Fi�ance Be�artmer�t, Licensc �ivision <br />2GG0 Civic C�nter Drive, Rosevilie, MN 55113 <br />{651) 792-7034 <br />:l�.ec;ycl�.ng I�[�u�er License .�►.p�l�cat�on <br />Fee Due: $125.U0 Year ��_� (License wili be for,ia�ivary 1 to [7ecember 31.) <br />Busi€�essTiame � � � J� 1 V <br />B�isiness Address � � /' 1 <br />�3�isiness Phone � � � � <br />Coneact Person <br />Eme��gency Cantact Information � <br />��mail Address <br />if completed license si�oulcl be mailed somew��ere other Ehan tl�e l�usiness address, please attach separate sheet. <br />Recycling services wi�l be provided tn (check all that apply): <br />��tesidentiai �Commercial •�'�Multifami[y�Industria] <br />N�in�ber of vehicles the applicant proposes to use in the coilection of reeyctables <br />Name anci address of cornpanies or materials r�covery faciIity where recyclab3es will be delivered: <br />�V ���Li"1Ne�i��t��� <br />..�.�7�� �i�lin���� �� <br />��� �������.� <br />Dffice paper/L3ox6oarct * <br />�� <br />s� <br />�` Glass* `i �� <br />Corrugated Cardboard* <br />`� <br />"lZec�uired items for residential and rnu(tifai�nily haulers <br />/� <br />Cans/Plastic * <br />C)ther(please specify) <br />fi <br />t I�ave been provided w€ct� a copy of the CiGy pf Rasevilie Curl�side Recycling brdinance and ui�derstand that violatinn of any af the <br />provisions incl�ded in the ordinance may resu[t ii� suspensian or revocatian the lic�nse, <br />i have attached a certificate of liabiliCy insurance, c r �ca.te indi ti g W 1 ei� Compensation coverage, and the fee of $125.00. <br />f � O�� '"' d _ � e V °`-�' `"'- �._.. <br />� Bate pp(ic 's 5ignate� `�itle <br />