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��l�E`�:.�- � <br />�:,.� <br />J <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />Sale of Consumer Fireworks License Application <br />Business Name <br />Business Address <br />Business Phone <br />Email Address <br />Renaissance Fireworks Inc <br />1625 County Highwy 10 Suite D Spring Lake Park Mn 55432 <br />612-638-7643 <br />mark@renaissancefireworks.com <br />Person to Contact in Regard to Business License: <br />Name Mark lazarchic <br />Address <br />Phone <br />1625 County Highway 10 Suite D Spring Lake Park Mn 55432 <br />612-840-3240 <br />I hereby apply far the fol lowing license(s) for the term of one year, beginning January 1, 2 015 , and ending <br />December 31, 20� 5 , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required Fee <br />Sale of Consumer Fireworks in existing retail business $.�Q(�00 -- <br />Sale of Consumer Fireworks as a sole business �$350.00 � <br />�� <br />The information that you are asked to provide on the application is classified by State law as either public, private or <br />confidential. All data will constitute public record if and when the license is granted. Our intended use of the <br />information is to annually update our records. Ifyou refuse to supply the information, the license application may not <br />be processed. <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville may from time to time prescribe, inclu�g Minnesot�t-�e #624.20. <br />��,,�,- � j ,/�-- <br />Signature ,% � = "` <br />Date <br />If completed license should be mailed somewhere other than the business address, please advise. <br />A FIRE SAFETY INSPECTION IS REQUIRED PRIOR TO THE SALE OF ANY <br />CONSUMER FIRE WORKS ITEMS. PLEASE CALL 651-7 2-.� 7341 TA-�-T�P� <br />AN INSPECTION. �'�� � <br />LICENSE TO BE PROMINENTLY DISPLAYED IN SALES AREA <br />�(� _ � y �s��— �'�"�/�% �� �{%<�� <br />�%r�pr �p `Ca� �/�Cc>�IY`� ��� <br />� nS�c� <br />