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CONTRACTOR LICENSE APPLICATION <br />JANUARY I TO DECEMBER 31, 2010 <br />FEE - $50.00 <br />2401 COUNTY HIGHWAY 10 * MOUNDS VIEW, MN 55112 <br />763) 717-4020 * Fax (763) 717-4019 <br />permits@ci.mounds-view.mn.us <br />BUSINESS NAME: <br />PHONE: FAX: E-MAIL: <br />ADDRESS: CITY: STATE: ZIP: <br />CONTACT PERSON: <br />OWNER/CORPORATE/OFFICERS/ASSOCIATES/PARTNERS (NAMES AND TITLES): <br />HAVE YOU EVER HAD A LICENSE DENIED OR REVOKED? IF YES, PLEASE PROVIDE EXPLANATION. <br />REFERENCES: OTHER CITIES WHERE YOU ARE CURRENTLY LICENSED FOR SAME ACTIVITY (IF YOU ARE NOT CURRENTLY <br />LICENSED IN ANOTHER CITY, PLEASE INDICATE WHERE YOU HAVE BEEN LICENSED IN THE PAST AND DATE LICENSED.) <br />PLEASE LIST AT LEAST THREE CITIES. <br />ARE YOU A MEMBER OF THE BETTER BUSINESS BUREAU? <br />DO YOU HAVE ANY OUTSTANDING COMPLAINTS FILED AGAINST YOUR BUSINESS WITH THE BETTER BUSINESS BUREAU? <br />AGE OF BUSINESS: (1-2 YRS) (3-5 YRS) (6-10 YRS) (11 YRS £x OVER) <br />HAVE YOU BEEN LICENSED WITH MOUNDS VIEW IN THE PAST? <br />I HEREBY CERTIFY THAT I AM FAMILIAR WITH THE STATE OF MINNESOTA LICENSING REQUIREMENTS FOR CONTRACTORS AND <br />THAT 1 AM EXEMPT FROM OBTAINING A STATE LICENSE FOR THE WORK I WILL BE PERFORMING UNDER THIS LICENSE. <br />I ALSO CERTIFY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT AND 1 UNDERSTAND THAT <br />ANY MISREPRESENTATION MADE HEREIN MAY BE GROUNDS FOR DENIAL OF THIS APPLICATION. <br />APPLICANT'S NAME (PLEASE PRINT): <br />APPLICANT'S SIGNATURE: