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�""� � <br />� <br />'��I��. �-� x _,,,�.�. .. _..i .f <br />Ciiy of Roseville <br />Finance Ilep�rt�nent, License Divis3on <br />ZGGO Civ'rc Center Drive, Rase�ville, MN 55�13 <br />(65�} 792-703a <br />IZecy�l�ng I3�u�er L�cen�e App�ic�.��on <br />�'ee 13�e: $125.00 Year v� °A � (License will be for January 1 to Decembe€• 31.) <br />BUSinessNa€x�e t��.ol;.... �5 •�,1�•.slw.> Sb�'.L ;.�,f,..5�-c � U•.SIti� .•..b 1.- �c.wo�.�..�( <br />Business A.ddress i�% o...,, �.c.. S.F , ..,�..,, � o� w, �'j'"! o <br />��G,S;���SS Pna�,� ( 5 !� �4 �s � — `� S �f �-- <br />Contact Persan .I 7 k.� �- �- ; e�'6�'� Fniaii Addres� <br />�_� � � <br />�'mergency Coi�tact Snformatian 5 °r, ^''L <br />Cf cornpEeted Eicense should be mailed son�ewErere other than the busi��ess address, �lease �ttach separate si�eet. <br />f�ecyc�in� sea-v�ces �.aill be provid�c! ta (clzeek all that a��ly): <br />Residential �oinmercial "'�Multifamily '�Industrial <br />�iun�6er of vehictes ttae apptica:�t praposes ko use in tl�e col}ectiorr of recyclabEes <br />�Iame a«d address of campanies nr anaterials recti�ery faciliiy wt�ere recyclables wi[1 be deliv�red: <br />� i Nev✓sp1rint* <br />}"r w r a.i'\.>s. �� [d 7.�1 <br />c! <br />� ti�� S� �� <br />� ��-- 5 5�� <br />Office pape�•/L'oxbaczrd * <br />��� <br />Glass * <br />Cori•ugated Ca�°dboard* <br />� 4 -�a. t� <br />*Required items for resideaitiai ax�d mu�tifamily haulers <br />�.s <br />Cans/Plastic'� <br />Other(please ,s�ecify) <br />I 1�av� been �rovided witla a copy of tl�e City af Rasevil�e Curbsid e Reeycling Qrclinanee and understand that violation of any of the <br />provisions i��cluded i�i the ardinance may resuti in suspeizsion or revocatic�n of the lice�sse. <br />I�ave attached a certi�cate af liability iiasurance, a certificate indicatin Worker Compensation coverage, and Che fee af $12S.QQ. <br />� � f (j y p / � /�„wa� .,_ � n''1 Ww, tcI`�i w � ,� �.� G✓ V / ,� r� J` • <br />➢ate Applicant's Signature "�""'�'`"'�`^� Title <br />