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�� ���r � .� � <br />� <br />City of Rosevitle <br />Finance Department, License Iiivision <br />2bb0 Civic Center Drive, Roseville, MN SSI l3 <br />{65�) 792-703b <br />Gas Pumps - Private Lic�nse Applicat�on <br />Busrz�ess h'ame �/QL�/►'� f/�� �S �Q�(l�,'%�T '� �f�� <br />� <br />Business Address �°J� ��(,�}l��1/� � ( _ <br />E3usiness Plzone .�� � � <br />E���ai] address <br />Pelson 10 Coiztact t�a Regard to Business Lice�ase: <br />�'ame <br />Address S ��"`�- <br />Phone ��.1 - ,�.� . , — . .— <br />] hereby apply for t�ie fo]lowiFig iicense{s) for the term of one year, begii.�ning Juiy 1, �(�� , and endiug Jwie <br />30, ��,. i�i t�le City of Rosevillc, Couuty of Rarrisey, State of Miiv�esota. <br />License Required �'ee <br />Gas Pwn�s - Private $60.40 <br />'E'he undei-signed ap}�lica��t ��akcs Chis a�plicatioii pu�•suant to all ihe la��s of t St'atc of Min��esota a»c� r��ulatro�� as <br />t��e Council aP the Cit�y of Rosev��l}e may fi�om tin�e to time �re�scribe, i�icl ia�g Min�iesota Statu ] 76.182. <br />� <br />Si�i�a;tn-e <br />Date � � 2 7 ��j <br />A fire inspection is e-epi�ired bef'ore issuance of a license. Plea;se c�ll 651-792-7341 to s�t up an inspection. <br />]f completed licei�se shauld be mailed somewl7ere other than the business address, plcase ad�ise. <br />