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� 1 .�.�r � <br />�.�' ' <br />�� <br />C�ty of Roseville <br />Finance Department, License Divisian <br />26b0 Civic Center Drive, Rcrsev�lle, MN 55113 <br />(551) 792-7034 <br />�ecyc�in� kIauler Licens� ,�pplicatian <br />Fee Due: $125.00 Year �� (�,icense wiI! be for January 3 to December 31.) <br />Business Name <br />Business Addre: <br />I3usiness Phone � — %�U � �� <br />I". . "�` . ! E <br />Cantact Person <br />�mcrgency Contacf Informafion <br />� Err�ail Address <br />If eompleted i€cense should be mailed sorr�ewhere ntirer than the business address, �lease attach se�arate sheet. <br />Recyclin� services wi�l b� provided ta (check a[l thaF apply): <br />�Resicter€tiai �Commerciai Ntuitifamily_,._,,._.,�Industrial <br />Ni�rnber of'vehicfes ilie appiicant ���oposes ta use in the caliection nf recyelables <br />�1ame and address c�f companies or maCerials rec�vesy facility where recyclabies will be delivered: <br />Jn' /� Neivsp�°int* <br />.r� PT � r LQr <br />}ei� � <br />Offtce paper/Boxhoarcf * <br />���- �.�r,� <br />�- <br />Glass * Cans/Plastic * <br />� 1���� ,�mwt�c c.� .���cl�...I� <br />Corrtzgate d Cardb oQrd * <br />���� <br />"Req�aired 'stems for residenYiat and tnultifamily haulers <br />Othe+°(please s�eclfy) <br />:���► <: � <br />�, <br />I have i�een providcd witt� a copy of the City of Roseville Curbside Recycfing Drdinance and uz�derstand that violation of ar�y of the <br />pravisioi�s included in the ordinanee may resvlt in suspension or revocation oFthe lice�is�. <br />i liav� attached a eerEi�cate c�f liabiiity insurance, a certi cat ndicatjz�g Worker Compensation covera�e, and the fce of $125.OQ. <br />�v D� �� <br />ba e licant's Signature Title <br />