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Scrag M etal l ealerf�l� n �ea1er1Recyciing Operation License Application <br />Page 2 <br />Leased by applicant —. — owned by applicant? <br />K. Are premises: � - <br />If leased: name of owner <br />Business address <br />r6 <br />4 O Q 0 <br />Vi. AFFIRMATION <br />1, hereby, certify and affirm that all of the information I application n is true and <br />accurate to the best of my knowledge. I further certify and affirm that l have <br />attempted to mislead the City in this application by om ing facts known to <br />. .-h e read <br />and understand the regulations of the Scrap Metal Dealer/Junk ¢� <br />c.�° 'n the C, 0i ,zouL� s Bend Viunicipal "'ode, Section <br />Operation /Trans er :�tcatiOn iic 3 �Se f ^v k 3u i <br />4 -51. <br />i Oq c-n <br />Z 1— -- Date <br />- Signature <br />