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2007_0507_packet
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2007_0507_packet
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1/10/2012 12:38:43 PM
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Roseville City Council
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Council Agenda/Packets
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�� <br />� <br />��F � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Amusement Device License Application <br />• � { <br />� ` R <br />�' i <br />Business Name � r r' � � �'� � I i �� �� { ����; �� � <br />• � i <br />_ � _�� i` _Yr ` <br />Li�iwi i��s :�tlJrt�� i � � � , f .�• � ti �- <br />� •—• <br />LSL1519L"'', 1�'1ti717L' _ 'l'��F�.? � I �• � � ' �1 yJ � �.� . _ <br />�_ _ <br />E�naa� Address <br />Person to Contact A� Rega�'d to Business License.• <br />r � 5 <br />?��in� %�I����',�� .�� � � d �� �� {� �`' ���.�lc•� �' � � �� ��'ffi'} } — <br />_ .� � � _� f � ����;� i�` � r-k-Ir ��i�� <br />A��{55 I ��' � � <br />��� � ��� � � <br />Pht�t�4 �.rE.. , . �'� �� + �� �' , __ -- • • - — <br />I hereby apply for t4�e �pllowing [icense{s} for the term of one year, beginning July 1, � v�? , and <br />ending June 30, ��� �_, in the Ciry of Roseville, County of Ramsey, State of Minnesota. <br />License Required Fee ►�ant�t Total <br />Amusement Device $15.00 / � ��� r� � <br />(per �nacl�ine} <br />The undersigned applicant malces this application pursuant to all the laws of the State of Minnesota and <br />regulation as the Council of the City of Roseville may from time to time prescribe, including Minnesota Statue <br /># 176. l 82. A <br />i <br />� .. • ,.� { <br />Signature _ ��• �'�'�•�� . � ��_ . <br />�' . <br />Date _ - —• ��—� � �� — <br />A fire Tnsnection is required before issuance of a license. Please call 651-792-7341 to set up an <br />insnec#ion. <br />If completed license should be mailed somewhere other than the business address, please advise. <br />
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