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Aug-02-2004 10:18am From-CITY OF ORONO +9522494616 T-643 P.005/006 F-014 <br /> CREDENTIAL CERTIFICATION APPLICA'T'ION <br /> C1{I"Y OF ORONO <br /> 2794 Kelly parkway, P.O. Box 66 <br /> Crystal Bay, MN $5323 <br /> Phone: 249-4600 <br /> Business: �a �, y AIR�;Phone: 7 Q_66 <br /> mainess and Home) . <br /> Address: ;qB r rl•6.,d Ave , /V, <br /> City:16„IYroe'J V"' .. r' State: Tp: <br /> Tpe of License Held: Master Plumber House Mover Other <br /> State License No. _ ExpirationAate <br /> Have you ever had a license revoked?. k"O - When Wim <br /> NOTE: The City does not have a special bond form to use. Proof of Workers Compensation <br /> insurance coverage is required for all contractors. <br /> Check kind of trade applying for: <br /> Septic Contractor (Required: MPCA Individual Sewage Treatment <br /> Systems License) <br /> House Mover (Required: $2,000 Bond, 10-50-100,000.Insuranee) <br /> Mechanical (Required: Copy of$25,000 State Bond& 10-50-100,000'Insurance) <br /> Plumber (Required: $2,000 Bond, 10-50-100,000 Insurance OR <br /> a copy of the State Plumbing InsuranceMond) <br /> Municipal connections (sewer/water) 'Yes �No <br /> �T <br /> Fire Sprinkler Installers (Required: $2,000 Bond, 10-50100,000) <br /> Work shall not commence until this application has been approved and required permits are <br /> issued. Please indicate any other persons authorized by you to apply for • ermits: <br /> 0 AL S i i9 , <br /> The undersigned hereby makes application to the City of Orono, Minnesota, for credential <br /> certification as indicated above, subject to the laws of the State of Minnesota and the Ordinances <br /> of the City of Orono. All applications are subject to a ten (10) day approval period. . If <br /> disapproved, written notice will be sent. <br /> Signature. l <br /> Date: 2— 0 , <br />