Agenda Packets - 2011/01/10 - Laserfiche WebLink

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PLEASE "X" TYPE OF LICENSE: READ THE FOLLOWING CAREFULLY: 1 HEREBY ACKNOWLEDGE THAT I HAVE TEN (10) DAYS IN WHICH TO PROVIDE A CERTIFICATE OF INSURANCE ISSUED TO THE CITY OF MOUNDS VIEW OR THIS APPLICATION WILL BECOME VOID. Liability Insurance Public Liability Per Person: $100,000; Public Liability Per Occurrence: $300,000; Property Damage: $50,000 Worker's Compensation Insurance This provision may be waived if the applicant is self-employed and no other persons are in the employ of the applicant. To waive this provision, the applicant must sign below that the above is a true statement. APPLICANTS SIGNATURE (IF APPLICABLE) I UNDERSTAND THAT I CANNOT CONDUCT BUSINESS IN THE CITY OF MOUNDS VIEW UNTIL THE INSURANCE IS SUBMITTED AND FOUND ACCEPTABLE BY CITY STAFF. I FURTHER UNDERSTAND THAT IF I PROCEED TO CONDUCT BUSINESS IN THE CITY OF MOUNDS VIEW WITHOUT ACCEPTABLE INSURANCE, I WILL BE IN VIOLATION OF CITY ORDINANCE AND SUBJECT TO DISCIPLINARY ACTION. NO REFUNDS WILL BE MADE AFTER TEN (10) DAYS OF THE APPLICATION DATE. APPLICANTS SIGNATURE FOR STAFF USE ONLY: DATE APPLICATION RECEIVED: Above Ground Tank Installation or Removal DATE OF COUNCIL APPROVAL: Building Mover - EXPIRATION DATE OF INSURANCE Chemical Fire Suppression REFERENCE OF OTHER CITIES: Deck or Step Installer (excluding concrete footings or under 30" high) STAFF RECOMMENDATION: Demolition or Wrecking Driveway Installer Drywall and Plaster Excavating or Filling (trenching, grading) Fence Installer Fireplace/Stove Installer (gas covered under HVAC) General Commercial Contractor READ THE FOLLOWING CAREFULLY: 1 HEREBY ACKNOWLEDGE THAT I HAVE TEN (10) DAYS IN WHICH TO PROVIDE A CERTIFICATE OF INSURANCE ISSUED TO THE CITY OF MOUNDS VIEW OR THIS APPLICATION WILL BECOME VOID. Liability Insurance Public Liability Per Person: $100,000; Public Liability Per Occurrence: $300,000; Property Damage: $50,000 Worker's Compensation Insurance This provision may be waived if the applicant is self-employed and no other persons are in the employ of the applicant. To waive this provision, the applicant must sign below that the above is a true statement. APPLICANTS SIGNATURE (IF APPLICABLE) I UNDERSTAND THAT I CANNOT CONDUCT BUSINESS IN THE CITY OF MOUNDS VIEW UNTIL THE INSURANCE IS SUBMITTED AND FOUND ACCEPTABLE BY CITY STAFF. I FURTHER UNDERSTAND THAT IF I PROCEED TO CONDUCT BUSINESS IN THE CITY OF MOUNDS VIEW WITHOUT ACCEPTABLE INSURANCE, I WILL BE IN VIOLATION OF CITY ORDINANCE AND SUBJECT TO DISCIPLINARY ACTION. NO REFUNDS WILL BE MADE AFTER TEN (10) DAYS OF THE APPLICATION DATE. APPLICANTS SIGNATURE FOR STAFF USE ONLY: DATE APPLICATION RECEIVED: Heating, Ventilation, Air Conditioning or Gas Line Installer DATE OF COUNCIL APPROVAL: Insulation or Vapor Barrier Installer EXPIRATION DATE OF INSURANCE Masonry or Cement REFERENCE OF OTHER CITIES: Plaster, Stucco or Lathing STAFF RECOMMENDATION: Shed Installer (under 120 sf) Siding (soffit, fascia, trim, gutters) Sign or Billboard Installer Swimming Pool, Spa, Hot Tub Installer Tree Trimming or Removal Certified Arborist No. (if Window/Door/Garage Door Installer Other READ THE FOLLOWING CAREFULLY: 1 HEREBY ACKNOWLEDGE THAT I HAVE TEN (10) DAYS IN WHICH TO PROVIDE A CERTIFICATE OF INSURANCE ISSUED TO THE CITY OF MOUNDS VIEW OR THIS APPLICATION WILL BECOME VOID. Liability Insurance Public Liability Per Person: $100,000; Public Liability Per Occurrence: $300,000; Property Damage: $50,000 Worker's Compensation Insurance This provision may be waived if the applicant is self-employed and no other persons are in the employ of the applicant. To waive this provision, the applicant must sign below that the above is a true statement. APPLICANTS SIGNATURE (IF APPLICABLE) I UNDERSTAND THAT I CANNOT CONDUCT BUSINESS IN THE CITY OF MOUNDS VIEW UNTIL THE INSURANCE IS SUBMITTED AND FOUND ACCEPTABLE BY CITY STAFF. I FURTHER UNDERSTAND THAT IF I PROCEED TO CONDUCT BUSINESS IN THE CITY OF MOUNDS VIEW WITHOUT ACCEPTABLE INSURANCE, I WILL BE IN VIOLATION OF CITY ORDINANCE AND SUBJECT TO DISCIPLINARY ACTION. NO REFUNDS WILL BE MADE AFTER TEN (10) DAYS OF THE APPLICATION DATE. APPLICANTS SIGNATURE FOR STAFF USE ONLY: DATE APPLICATION RECEIVED: FEE: $50.00 RECEIPT P. DATE OF COUNCIL APPROVAL: LICENSE # EXPIRATION DATE OF INSURANCE NEW RENEWAL REFERENCE OF OTHER CITIES: BETTER BUSINESS BUREAU CHECK: STAFF RECOMMENDATION: POLICE CHECK (IF NECESSARY): 2 -