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CREDENTIAL CERTIFICATION APPLICATION <br /> CITY OF ORONO <br /> 2790 Kelly Parkway, P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> Phone: 249-4600 <br /> Business: Xcl.:_f i/,,,' L�;, Phone: _ y 93 • <206 a .Same- <br /> (Business and Home) <br /> Address: /g5 a y 9 S ' (--/9,e <br /> City:/0/4p fdove_ State: /0//1/ Zip: SS 369 <br /> Type of License Held: Master Plumber J` House Mover Other . <br /> State License No. 3 8a6 pm ExpirationDate /d? - 3/a2 C 0 <br /> Have you ever had a license revoked? Af 6 When Where <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 Insurance) <br /> Mechanical (Required: $2,000 Bond, 10-50-100,000 Insurance) <br /> )c Plumber (Required: $2,000 Bond, 10-50-100,000 Insurance OR <br /> a copy of the State Plumbing Insurance/Bond) <br /> Municipal connections (sewer/water) Yes No <br /> Fire Sprinkler Installers (Required: $2,000 Bond, 10-50-100,000) <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 permits: <br /> /Vô&e <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: �i v Date: g - -- 0O <br />