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Feb-16-2005 09:36am From-CITY OF ORONO +9522494616 T-59T P.Op2/D05 F-410 <br /> ' • . <br /> CREDEN�AL C�RT�CATION API�LICATION <br /> CITY OF ORONO <br /> 2790 I�eUy Parkway, F.U. Box 66 <br /> Crys�al Bay, MN 55323 <br /> �bon�: 249-4600 • <br /> � Business: fP�C'� Y�1`Co���c� t� b�n Phone:763- `�6f/_,?�7;3-��y/G-J'�63 <br /> / r— cAusincss and I�omc3 . <br /> A.CtCu'eSS' �.5�.3 b �`��`' l9�c. /� ' <br /> City:,�/�Q�,�� Grovc State:�.�. Zip;,,,?S'3l� <br /> Type of License Held: NIaster Plum'ber� House Maver Oiher • <br /> State License No.0055� t�m F.�cpirationDate /�- 3/- D� <br /> Have you ever had a license revoked?� 'When Where � <br /> NOTE: The City dQes nat have a specia� bond form to use. 1'ruof of Workers Compensa�ion <br /> insurance cov�rag� is required for a11 contractors. <br /> Check kind af trade applying for: <br /> Septic Contractor (Required: R�PCA Tnd.ividual Sewage Treatcuent <br /> Systems License) � ' <br /> � House Mo�ver (Required: $2,000 Bond, 10-�0-100,000 Insurance) <br /> 1VZecha�icaI (Required: Copy af$25,404 State Band& 10-50-100,000 TnsuranCe) <br /> �� Flumber (R.equire�: $2,000 Bond, 10-So-100,OQQ �asurance �R <br /> � a copy oF the State Plumbing Insurance/Bond) <br /> 1Vrunicipal conz��ctions (sewer/water) Yes ��No <br /> Fire Sprinkler xnstallers (Required: $2,aoo BoAa, 1G-SQ-IQO,OOd) <br /> Work shall not comm�nc� until this application laas bEen approved and required p�nmits ar� <br /> issued. Please iz�dicate any other persons authorized by you to apply for ' persnits: <br /> v��it2/1 c `1' �Co/y� �_ <br /> The undersigned hereby malces application to the CiCy o� Qrono, Minn�sota, for credential <br /> eertifieation as i�,dicat�d above, subject to the laws o�the State of Mi�tesota and the Ordinances <br /> of the City of O�ano. Ali applicacians are subject to a ten (10} day approval period. Xf <br /> disapproved, written notice wiI1 be sent. <br /> // 1 <br /> Sigaaatuze: ���!�� ���z�— , Date: o�— ��- �,,,,�'r' .: - <br /> �--,�, <br />