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��� <br />s 1 , _ -1.,..,: .1 J <br />City of Rosevilte <br />Finance Department; License Division <br />2560 Civic Center Drive, Roseville, MN SS113 <br />(65l)792-7Q36 <br />l�ecycling I�au�er License Application <br />Fee Due: �125.(�0 1'ear �th17 {License �vill bc for January I to �ecembcr 31.) <br />Business Naine <br />�3usiness A�ldress pa. ,.�e�( �% ��4 Pw+� /�'l�iJ �0 "• ' <br />13u5F�,��s P�,���e 7ro. ?- 1�— Sy` �f <br />Contact Pcrson �.iG � L��:�,� Emai1 Address _ <br />v <br />Emcrgcncy Contac! IF�Formatiot� <br />li' co�n��leted lice��se sl�ould be maifed some►rt�ere otfier tl�a�� the busi�iess address, please attach separate sheet. <br />Recycling scrvices ���ill bc providcd to {check alf tl�at a��ly): <br />Residentiai,___� Commc��cial��Multifamily� Indtistrial <br />Nu�nbet• of� v�l3icles the applicai�t proposes ta usc in the collection of recyclaUles � <br />Name and address of con�panics or materials recovery facility wliere recyclables will be dclivcred: <br />Nc��+�s��i�iirt * Glc�ss * Cans/Plastic * <br />�F+�A��2�c.,� �..d���. �_ ��,�.�.�. _ <br />��� <br />Office pUpe�/Bo.xhoa�rf* <br />� f �: <br />._J <br />% <br />Ca•�•ugated Cc7rd�om�d * <br />�� �� <br />____ ��� <br />*Rec�uircd items for residen€ial �jnd :nuliifamily haulcrs <br />Otlaer(please specifyJ <br />I have bee�7 provided �i�itl� a copy of the City of Roseville Curbside Recycling Ordinat�ce and understand that violatio�l of any of tl�e <br />provisians included in the ordis�ance may result i�i suspensio�i o3� revocation of the ]icensc. <br />E havc attached a certificat� of liability insurance, a certificat ii�dic� � ig Workcr Compensation coverage, and the fec of �125.00. <br />/o a � a ���?� A�L�C <br />ate App cant's Signaiure Title <br />