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��� r � <br />City of Roseville <br />Fir►ance Department, Li�ense Division. <br />2660 Civrc eenter Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />Amusemen� Device License Appl�cation <br />Business Name �L�,) - t <br />$usiness Address � 3f �. �� A'1!� <br />Business Phone � Sj `� �� "�SO � <br />Email Address -- -- _ - <br />1'erson to Cantac! in Regard to Business License: <br />Name <br />Address <br />Phone <br />I hereby apply for the following Jicense(s) for the term of one year, be�inning July 1, �� , and <br />ending 3une 30, ,��( D , in the City of Roseville, County of Ramsey, 5tate of Minnesota. <br />License Required Fee uantit Total <br />_ � <br />Amusement Device $15.Q0 � T Q -'" <br />(per machine) <br />"Fhe undersigned applicant makes this application pursuam to al] the laws of the State of Minnesota and <br />regu�ation as €he Council of tt�e City of Rose�i]]e may from time to tirtie prescribe, including Minnesota Statue <br />�176.182. <br />Signature U.� Ll�G-� <br />Date ��'F�D l .� .. . ... <br />A fire ]nspection is req�ired before issuance of a. license. Please cail G5l_792-7341 to set t�p an <br />inspection. <br />[f completed ]icense should be mailed somewhere other than [he business address, please advise. <br />