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� � �t <br /># �' �` � ;�... <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Cen�er Drive, Roseville, MN 55113 <br />{G51) 792-7036 <br />Amusement �evice License Application <br />Susi�ess Narne <br />Business Address <br />Business Phone <br />Email Adciress <br />�!' � va���� <br />:� �U � 5��� � l-= h��.:s��i�.�.�. f%%, -s.�"/��� <br />�/ �� ��� � �' � :� <br />Person to Contact in Regar•d to Bu.siness License: <br />.�• <br />Narrie v U,Q/ %/f � �%�f/i'.�; <br />�---�. <br />Address <br />Phone <br />� -• --- �.•-- <br />� <br />r <br />,� - . _ .e> <br />/ N� <br />i i�ereby� apply far the fa1lowing license(s.) for the term of one year, beginning July 1, �/� , and <br />ending June 30, ��/i, , in ihe City of Roseville, County of Ramsey, State of M3nnesota. <br />Y.,icense Required Fee uanti Tota! <br />Arnusement Dev�ce $15.04 1� ���� �� <br />(per msciiine} <br />'!'he ��ndersigned appiicant maices this application pursuant to a[l the iaws of the State of Minnesota and <br />regulation as the Cauncil of the City af Rosev�lle may from time to tirrie prescribe, including Minnesota Statue <br />#176.i82. ,_l . <br />` 1� /9 /� / <br />Signature � �c�. lCf�' � ''�:�cr'C�.�%X��� <br />Data `° / <br />A fire inspection is required 5efore issuance of a license. Piease �all 651-792-73a1 to set up an <br />inspecti,nn. <br />[f completed license shauld be mailed somewhere other than the business address, please acEvise. <br />TL. t�'i�� �. �1�� 1� % fi .' /L�i�'1 �'� �.i /�f`�'%`,(����i''���i /�1�. <br />� <br />�D � , � ��7l9� <br />� % � �Ur"��4�y 1✓�'; <br />/��-�-�-5��1 11:�� �l , �4 /1J � <br />