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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: 473-7357 <br /> Business:� � �� ���_�,l•1� � '��Phone:�� � - g�J�' � �/�J` -��� <br /> (Business and xome> <br /> Address: �� 1 � f c7 C �� �� <br /> City: S �}�� �� � �� � _ State:_y�r�+ �_ �P� �C 3g`�' <br /> Type of License Held: Master Plumber House Mover Other <br /> State License No. ExpirationDate <br /> Have you ever had a license revoked?�_ When �� <br /> NOTE: The City dces 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 �..�Required�._$2,.420 Bond, 10-50-100,000 Insurance) <br /> —�---.___.�., <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 Iastallers (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 /> � 1 �� � � I � L--- - � "�1�1 �`/l� 1 (_t,- <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 ill be se . <br /> ( <br /> Signature: Date: �` � � ` � � <br />