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lv'� <br />� <br />City of Roseville <br />Finanee Departrner�t, Lice��se Divisian <br />2660 Ci��ic Cen#er Drive, Roseville, MN 55113 <br />(651)792-7036 <br />laecycling I�au�er L,icense Application <br />ree Due: �125A0 Year ,� �% �`� {I�ice�zse ���il] Uc for .tanua�-y 1 to Deccmbe.r 31.) <br />Business Na.�tte �t.��i� y j <br />Busincss Address �v � C c.` ^'`�' /�..•c <br />Busii�css Plionc �' � � ` `�`�7 �' <br />Contact Pei�soiz L1 � � �- Z-�, �.c- � �� Email Acic3ress . � ,_..,, . _ <br />�'mergency Contact Infoi-mation �.•-�"-� <br />IicompleEeci litense shouId be �nailed some�ti�here otiier than the 6usi��ess address, please attacl� separate sheet. <br />Rccycliug scrviccs n�ill bc provided to (chcck all Ihat apply): <br />� Residential 'r Con���let�cial r Multifamily Industrial <br />Number of���chicles tl�c applicant pi-oposes to use ii� tl�e collecTion ofrecyclables � <br />Nanie and address of companies oi ��laterials recavery facility wl��re recyclables will be delivered: <br />� Neiv.s�r-riat * <br />�c + <br />� °�'' C-���I �• f"� "�, <br />a- <br />c� `� ?�� h-c�-�.�. j.,� f j� r, <br />i��s��S ��.� �-S`"� '�13 <br />f�fJice I�ape,•/Bo,rbon�•d* <br />� <br />GlUSS * <br />�I <br />Carrugafed Curd6oard* <br />*Required items for residential anci multifamily hau�ers <br />I� <br />Ca,�s/Pla,rtic * <br />� <br />Other(please spectf �) <br />� <br />[ liave bees� provided witl� a ca�7y of the City of Itoseville Cur6side Recycli��g Ordina��ce and undea�stand that violation of any of tlic <br />F�rovisioi7s included iti the ordi�lance may result in suspeiision or revacatior� of Che license. <br />] l�ave attached a certificate of liability insuranee, a certificate indicating Warker Compensation coverage, and the fee of S 125.00. <br />C� _ ._ p � _ L' '� _ � !�+t�. i� � M w.it_ � r-:� • <br />Date pp �cant's Signaturc Title <br />