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����� � 1 � <br />� <br />City of Roseviile <br />�'inance Department, License Division <br />2660 Civic Center nrive, Roseville, MN SSl l3 <br />(651}792-703G <br />Amuserr�enf Devi�e Ilicense Applxcation <br />Business Name rn.n -�l+r� � F � �.C:� <br />Business Address o� m� (p ,� � �-� �_ __� � _ C. _ � , k,,,� J�l.�! .�. �'�_ <br />Business Pho�1e "-'�- �� - q 3 b G,� <br />�� � <br />Email Address � �.r t �.r _ � "� "'� <br />� <br />Aersan to Cnntacl iti Regard to BKrsir�ess Licef�se: <br />Name <br />Address <br />� <br />Phone � <br />.�— <br />� <br />�� � � <br />1 hereby apply for tl�e foilo�ving licei�se(s) for tlie term of one year, be�inning J�ily I, �pDGj , and <br />cixling Jui�e 30, a.0 �� , in the City of Rosevi�Ie, Couiiiry of Ran�sey, State of Minnesoia. <br />License Reqi�irerl Fee uanti.h' Total <br />Amuseme�[ Device �15.00 � ( � ��.�� <br />{per machi�e) <br />The uncicrsigned appiicai3t makes this applicatian purstFant to all thc kaws of the State o; Minnesota and <br />regu�ation as tl�e Council oF the City of Roseviile :nay fran� tin�e to tinie prescribe, inc-l��ditig Minnesota Stattie <br />#17b.i42. <br />Signature • <br />� G�1�� <br />A f�ii•e lns ectian is re uired before issuance oF a iicer�se. Ylease cal! 651-792-7341 to set u an <br />inspeCtion. <br />lf completed license s�iould t�e mailed somew��et-e other than the t�usiness add��css, �lease advise. <br />� � �,-� 5 l �v �.. ��-e-� - � � 1�. o �.-�, �-�. 1 � ��,. �,rc.� <br />�S � �. o � �,1 �. C:�-,. �-�r <br />�o �--.�: �\ �� � � � � � 3 <br />