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CITY OF GEM LAKE, MN <br />4200 Otter Lake Road <br />Gem Lake, MN 55110-3227 <br />Telephone 651-747-2790 <br />E-mail City0,gemlakeMN.ors <br />BUSINESS LICENSE APPLICATION <br />Name of Business: <br />1 rl C' <br />Address: �C% % �I C��✓�'!G� 6i (i e u/l f� J l C7 <br />Owner Name: -e ( 'e.o o ScL 't o S C.C�_a v f <br />Address: (3 t C�, Av< Ka p(-e(.0 c) 4 d S 5-1 Pq <br />Business Phone. Home Phone: <br />Cell Phone: �l <br />Type of Business Conducted: nv IVLU� w-e- <br />Number of Employees: <br />ENCLOSED IS THE SUM OF $75.00 REQUESTING THAT A BUSINESS <br />LICENSE BE GRANTED P RSUANT TO CITY ORDINANCE NO. <br />pplicants Signature Date <br />♦ Licenses are valid January Vt to December 315t of each year. <br />To Be Completed by StafF: <br />Date Request Received: 1-9 7 - 1� 1 <br />�v: <br />�E UI�I } /1.C.A u �Il � C� $75,00 Fee Paid <br />V -- <br />License Approved: ❑ Yes Date <br />0 No <br />P' Yes <br />❑ No <br />Look for us on the World Wide Web at gemlakemnorg <br />