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_ ��� � �� �, <br />c�� �� �zA����l�e <br />Finance �epartrnenf, �icense Divis�on <br />2660 Civic Cent�� Drsve, Roseville, MI�i 55113 <br />(65�)792W7034 <br />r. � �.��� - �,� .,; �,.;,. .� � : - <br />w <br />, 1 ', .. !: : : <br />Fas Due: $125.04 Year �-� (L'scense wilf be.�ar 7anuary I to �7ecember 31.) <br />I3�asiness Narrse <br />iiusiness Addre <br />E3usiness �'hane �o�� ' ��i�' ?� <br />Gontact I'erson <br />Emergency Contact Informatian <br />�mai! Address <br />if complafed [icense should be mailed somewhere atlxe�° than the business ad€Iress, piease attach separate sheet. <br />Recyeling serEr:ces wii4 be provided ta {chec�C atl that apply}: <br />W Residential � Commercia� .V Mu(tifamily V Tr�dustrial <br />I�I�mber af ve�icles the applicant proposes to vse in the col�ection ofrecyclat�les � <br />I�ame ar�d address af companies ar materials reeovery faciIity w�ere recyelables wilf be delivered: <br />News�rint'� G ass* }� Cans/Plasaic* <br />�IAY t1 � ,.�C C ��,t����_m_.....,�i°..`.U��:�i,C.��,,, , _���-__��.�_—_�-- <br />�c�Z,`� �.�'�1�� ��. N� �� � �Y) . �. 2 ��z `�. � <br />����,r�o������ ���� �r��� ��>��13 �.�� `s `� � <br />(Jffce paper/13oxbaard * Carrugated Ca�•cf6oard � <br />Other(please specifyJ <br />� { � �.0 C� 4 �lt � „� ��.Y'�9,. �Q ���� �t v'��- '�� C' 1��_ <br />�42R ��I� G'� �� � 2�2 � � �� 2-� �!'� � �� <br />'c �:�� � �� �''� �.� H�� s�- � t�,�s � 1.� <br />*Required a ms for �esidential ar�d multiFamily hauters <br />1 ha�e been provided wiCh a copy of the City o�'Roser�iile C�rbside itecycling Qrdiaance and undersfand ti�at vialation p�'any af the <br />pravisinns ineluded in tl�e orcilnance may re ult � suspension or revocation of tt�c license. <br />I have attached a certiftcate of liability insurarnccyl� certi�caic indicating Worker Campensaiion covera�e,�the fee of $I25.Of}. <br />� ��o� <br />l�ate A p i ant's Signature Title <br />