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Jut—CT—ON 09:O2am From—CITY OF ORONO +9522494616 T-191 P 002/003 F-332 <br /> 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: pt,L,,,-9-n.-f, Phone: 95./ 6 C. / <br /> � n (Business and How)Address: 9 6 q /'�`�' . <br /> City: Zei,--9-7-/-4. -/-ts- State: ) ' Zip: cSSC�3 <br /> Type of License Held: Master PIumber House Mover Other Y'1.49G <br /> State License No. ExpirationDate <br /> Have you ever had a license revoked? IVO 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 /> 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 •ersons autho : e• by you to appl i for p-rmits: <br /> • 4 '// , <br /> ' / A _- -4 <br /> The undersigned hereby makes application to e 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: Date: <br /> fi <br />