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CITY OF ST. ANTHONY <br /> f • <br /> APPLICATION FOR LICENSE <br /> i <br /> Article No. Section No. Date: <br /> i <br /> i <br /> j NAME hereby submits application for a license to <br /> i <br /> perform within theeCity of. St. Anthony in accordance with <br /> the code of said City regulating the same. <br /> Submitting, along with this application, is a $.2,000 License/Permit Bond <br /> (March 15 to March 15th concurring with license year) payable to the City of St. Anthony, <br /> conditioned upon compliance with -the applicable code of said City, and Certificate -of <br /> Insurance in the limits of $100,000 per person, $300,000 per accident for bodily <br /> injury and $5,000 for property damage, and a Certificate of Insurance evidencing the <br /> the holding of Workman's Compensation as required by law. <br /> Company or Firm Name <br /> Address City Zip <br /> Telephone Number <br /> Company agent or official 1. <br /> 2. <br /> 3. <br /> State Master License No. (When Applicable) <br /> Licenses in nearby cities, villages, or state <br /> APPLICANTS NAME (in Full) <br /> (Print) <br /> APPLICANTS SIGNATURE <br /> (DO NOT WRITE IN SPACE BELOW) <br /> Amount $ DEPARTMENT REPORT <br /> Date <br /> Receipt No. <br /> Bond _ <br /> Insurance <br /> License No. <br /> APPROVAL RECOMMENDED <br /> DENIAL RECOMMENDED <br /> BY: <br />