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��� <br />1. J , _, J �' J <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(65l} 792-703G <br />l�ecyeling I�au�er License Applica�ion <br />������ e�� �� <br />Fee Due: �125A0 Year `�.% (Liccnsc �vill be for Jan�iary ]. to December 31.) <br />Biisincss I�'an�e � t:� � � � �� ° a y< � � . � dd/` �� �" a��_ /�'!� <br />E3usincss Address <br />B��siness Phonc 1�1_� `- � � � ' � L° _5 �.� <br />�y <br />� � � � c:Z � � � <br />° , ��, .�� // <br />ContactPerson�;� c�°�'..� �t�v�� �.�+;�'��.�._�mai] Address �� -�f�°`C1 c� �����'�� ���L��-: �L`''� <br />Emcr�ency Contact InforFt�atio�� <br />lf' co�i�pleted iicense shauEd be aiailed some«�liere otl�er than the busiuess address, piease attach separate sheet. <br />Rccycling services �vill be provided to (check al] tEiat apply): <br />`� Residcutiai � Commcrcia]__� _ M��Itifamily�Industrial <br />i�tumber of ��ehicles flie applicant }�roposes to use in tl�e collectian of recyc�ab�cs � <br />Na��le and address of co�npanies or �tlateriais recovery facility where rccyclables will be deli�-ered: <br />(`rC'S1'5�71"I1Tl * <br />���� �=�-��`�� i <br />OfJicc papc�/I�n.rbnurd* <br />G(as•.s * <br />Cors�r�gnled Cardbourd * <br />� <br />*Required ite�r�s for residential a��d multifamily k�aulers <br />Ca�ts/Plasti c * <br />Odlze�•(please specify� <br />I have been provided with a copy of tl�c City of Roscville Ctu�bside Recyciing Ordin�ulce a�id understand tl�at violation of any of the <br />provisians included in the ordinancc may result in suspei�sion or revocation of the license. <br />I l�a��c attaChed a ccrtificate of liability i��sui�aiice, a certificaie indicatinb Worker Compensatioi� coverage, and the fee of 51Z5.00. <br />9 / ry <br />( I <br />l � <br />--- � I` f.• �� /` ..�_ _ �1.���-1 -�� >��,�'�' ;��t 1 !�.'���.' "� <br />, <br />Date Applicai3t's Si�;natur� Title <br />