CITY OF FRIDLEY
RENTAL PROPERTY INSPECTION DIVISION
FIRE DEPARTMENT
6431 University Avenue, N.E.
Fridley, MN 55432
Office (763) 572-3616 Facsimile (763) 572-8825
APPLICATION FOR RESIDENTIAL RENTAL PROPERTY LICENSE
DATA PRIVACY NOTICE: The data you supply on this form will be used to assess your qualifications for the license. You are not legally
required to provide this data, but we will not be able to grant the license without it. If a license is granted, the data you have supplied will
constitute a public record and copies may be issued to anyone requesting them. The required data allows us to distinguish you from other
applicants; to identify you in our license files; to verify that you are the person who applied for the license; to contact you if any additional
information is required; to determine whether you meet any minimum age requirements; and to determine if any conviction you may have on
record might affect your suitability as a license holder. Your residence address and telephone will be considered public data unless you request
this information to be private and provide an alternative address and telephone number (see below).
Please sign to indicate that you have read this notice.
Signature _________________________________________________________________________
I request that the “Property Owner Information listed below be considered private data. My public business name, address and
telephone number are as follows:
Business Name
_______________________________________________________________________________________________________________
Address
___________________________________________________________________________________________________________________
___
City, State, Zip _____________________________________________________________ Telephone Number
________________________________
TO THE CITY COUNCIL OF FRIDLEY, MINNESOTA: The undersigned hereby makes application for a residential rental
property license in accordance wi