Laserfiche WebLink
Sop-t2-Z�O� !�:5dpm Fr:�,-C{TY OF O�C'��� +95����r1�',6 '-OiE P C0�/QOT F-OC9 <br /> • < <br /> . <br /> �;lE�.�;;.)EIv'T:�.7'< i::ks�TIP'iiGA,'i'IO1V �'c'P�..ICAi`�`I�h' <br /> C�"I"Y (I�' �FCO:'�'O <br /> �75Q ii��l�� P't�`'kvvay, P.�. �0� �fi <br /> �rystal B�a�, Mli 55�3�3 <br /> Ph�n�: 243-460Q <br /> � ,�, , <br /> �usi�ess:���irlL t�t���►� � �9ir C���.� Phone:.�..�,?'D�8� --� `�d`�-- - - <br /> ...�....�_`.____ (�'u��n�ss an�*�;,mc> . <br /> Ad3zess`^.�,°..� S Cc,�fryf a.,c.� -- --- __�. , --�..___._ <br /> Ciry:�ert-c� .r.�..__._.__.____..___r__�__ �'.:.tie. l��.�.i ... �F=--- �3� . <br /> �ype Q€�S..icense �eld� M�ste�Plr��b�:--- -- - ilouse Mov�r _.__ Other� <br /> Sta�e Y.,icens� Nr�.. _..... �____�,.._. F.�cpfragionY3a.t� �_ <br /> F�ave vau ever �Sa� a li��r�.c� r:vak�d?^_ 'W�en�� 'PVh�r�_�.._ _ <br /> NQ'��: 7� Cit� do�s t3c�t h3v� x �.,'cial bvz� foim to use. �'x��wf�f�`orl�ers Comp��.�nsation <br /> iriSt�r�C� CUv��� iS r�quirNd f�i �I� ca��=u:tozs. <br /> C��ck k�.nd vf 4rad� a�ply�ar�; fc�r� <br /> _.W.,.._� �eptic Co�tt�ar�c►.r� (gtequired: M�'�=A Iad'tvidual Sewage Treatmen� <br /> �yse�.-�s Li��ns�) . <br /> �ious� '.12.c��er {Fter�u%.�ed, �2,C}C14 ��r�d, �0-56-IOO,t�t1 Ir�surance) <br /> �� n�ec�i�:cal (T�.�r�uired: �2,t�1� Bt�nd, iG�50-�U�,d00 Insuran:.e) <br /> Plumb�r. (�'.equzred: �2,t�(30 Bonci, 10-Sf�-i00.00G I�suxance OR <br /> l a ��� of�ie State �'Iurntimg InsurancelBond} <br /> Mu�a�i�al �orinactions (sewerlw�r�c�) �___ Y�5 � Na� <br /> .�.,- ---_ Fire Spt`�xz�Yur In.stati�x's (R��ttixed: $2,�(� �3c�nd, 10-�0-100,OD4) <br /> Work s7aa4l �ot cozn.*n�nce u��til Yhi� applicatian has been a�:pr�ved and required ���ts are <br /> iss��d. F1��.�e indieac� any t�t�er person� authorize�. t�y yc�u lo ap�ly for per.r4..its. <br /> _�.�--..�___.._._..__��._ �__�______^ .J--�- � <br /> 'ihe un�ersi�nLd lzereby r�iakes a,�pli�ation [o the Ci:y af Qro��: Miruzesota, fc�r �r�dentia� <br /> certifi�adbra�S ir�i�.aYc}� �ov�, ;�u�jecC ta the laws of�.ze �t,�te c�f Mia�nesota and the �Ordin�r�ces <br /> oT che �;'ity of Ort���i. All a�plicaticns �re subject to a ten (1.0) �day a�proval p�riod. �� <br /> disa�grc�v�C, writcen notiC: will be sent. <br /> �i�r�re� �-e� ���G��_�_.�. Date:___�-� g_��3-.-- <br />