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. - <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: ��,r�'�+ w.��+ �rr��n,�a� Phone: 7 6 _�-�� � l��5— <br /> Address: � `�G�- i r' (Business and Home) <br /> /U a 5T1'QQ+ <br /> Ciry: �; n� L.l��k� state: (�'�,�J zip: 5 S 3 C� j <br /> Type of License Held: Master Plumber� House Mover Other . <br /> State License No. �c� ��,f3 �- A� ExpirationDate /�- 3/���p � <br /> Have you ever had a license revoked?� When Where <br /> NOT'E: 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, 10-50-1009000 Insurance) <br /> �_ Plumber (Required: $2,000 Bond, 10-50-100,000 Insurance OR <br /> a copy of the State Plumbing InsuranceBond) <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 pernuts: <br /> d�.1��(. S,N� , �..�vlz-,1� ��� ,��Z� � j��e„� 7��P��rt/C� � <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 w 1 be sent. <br /> Signature: , �� ��` Date: D ��� _�J - <br />