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cnT OF *GEM LAKE <br />_w 4200 Otter .Lake. Road <br />Gem Lake, MN 55110-3227 <br />651-747-2.7qO <br />BUSINESS LICENSE APPLICATION <br />Name of Susincss: Sanibel Dance Company, LLC <br />Address- .3591 Hoffman Rd <br />&reel A i A ifcss <br />:Gem Lake <br />dify <br />Business Phone; 661 -3087774.8 <br />Applicant: Amber* Hom <br />Mailing Addmss-, _,3591f HoEmP.6 Rd <br />Gem -Lake <br />city <br />Businbst. Fax., <br />55110 <br />stars Z7P CU* <br />Stara SP Ca* <br />Applicant Kamp: 651-308.7748 Appllcant,-Cell:.!5, <br />MN Tax ID 4077182 Federiji. I ax 11) 47 -4.283867 <br />.(p& State ,Statute 207C :2,.5jjj)d, 3) 51,7111to <br />type. of Stminess: - Dance instruction <br />Number of <br />EM0.1.0yees. 3 <br />Endosed-ls-the,Suni of $100.00-requesting.-that a 16UMn6ss license.be granted pwsuant to City ordinance <br />#84. The-huslhess liceme is valid ]a n uary 11t to December 3 111 of each year. Upon license being <br />granted, the undersigned agrees to comply with all ordinances, riflesand regulations of Gem Lake: <br />Applicant Signature: <br />Date: 06-16.15 <br />Deposit of the check by. the City does ifdt*cbnstifute the issuance of a busin ersljcense <br />Fee Pod, bate: <br />I n skm* h. Mi te.- <br />L i40i,ov. <br />unse ed: Date Approved-. <br />5:.1TEM PLATES& FORM S\BUT 1; 1) 1 NG14 E 14. t Ak F,Gv I I. ke 3% w wsn Ucense Aj)pSc.r)1ion.(Ajr,:x <br />I <br />