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Oct -22. 2013 11:03AM Xcel Energy Edina Construction <br />G <br />City of Mounds View <br />2401 County Highway 10 <br />Mounds View, MN 55112 <br />763-717-4000 <br />�/No.18087 P,_ 1,y <br />Application for Advisory Commissions and Committees <br />Group(s) applied for: <br />ST-ee-5 as <br />Full Name (Please Print): (0,40 y L -e L <br />Work Phone: / � �'�% �i5rr�3 Work/Cell Phone: 612 - <br />Address: %y 05- <br />Years at this address: o, Years you have lived in Mounds View: <br />E-mail Address:. a/%O-/ r L• X"117A & X0'0 -/9A/ e/,5,N E A r <br />Experience and Qualifications <br />�% <br />Skills and Interesf D 111 t r5 (� 7r 5 5 rCl?- <br />Employment, Occupation or Other Relevant Experience: <br />xeefe'yersy /f'�hFc�z °I'� c�igrg (/�✓! (�°r/�r� <br />Memberships, Accomplishments or Other Qualifications: <br />r(47ul-t e -g Ca," . <br />Please state your reason for wanting to serve with this group: <br />Date: /0- Z Z — C <br />(Your re&ronse to any of the above inquiries may he continued on the back of this form and you <br />may attach other information that you would like the City Council to consider.) <br />The City of Mounds View is committed to the policy that all persons shall have access to its programs, <br />facilities and employment without rogard forraco, ethnicity, sex, age orphysicol obilitles. <br />