Laserfiche WebLink
City of Falcon Heights <br />MECHANICAL CONTRACTOR°S LICENSE APPLICATION <br />TO: City of Falcon Heights Fee: $ 0.00 <br />2077 West Larpenteur Receipt #~ <br />Falcon Heights, MN 55113 Date: ~1o-Z~-a.S <br />651-644-5050 <br />651-644-8675 (fax) Expires: 12/31/05 <br />Firm Name : ~ ~~- ~ ~ `~ ~~, ~ , ~-`~ <br />Business Address : ~®c~l 4''? ~` ( {~~~ <br />el ~f ~i <br />Telephone : '~~ ~ ~ /~~ -~ f~- Fax No <br />~.1~ ~ ~ ~~ <br />Name of Owner: ~ <br />Home Address: <br />• <br />Telephone : ~^~ ~...~ ~~~ ~ Qty aec~c, -~, eJ ~ <br />MK~f~ <br />City of St. Paul/MPLS License Certification Number: S~"``` ~pOoO°©~G?~ <br />City of St. Paul/MPLS./other Major City C of C Number: <br />List Your Experience : ~~;~ ~ ~~~r (~l~c'~ ~r ~ • <br />~- <br />ITEMS REQUIRED FOR LICENSURE: <br />• Insurance minimum of $300,000/$500,000/$100,000 <br />(The city of Falcon Heights should be named as additional <br />insured.) <br />• State of Minnesota Tax ID Form <br />• State of Minnesota Workers' Compensation Form <br />• Proof of insurance must be furnished with application and <br />must it~.dicate 10 days notice before cancellation. <br />I swear that the above statements <br />are true to the best of my knowledge <br />and belief. <br />~/,~ Signature <br />• <br />