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��1� � <br />���� <br />City of Roseville <br />Finance Il�.ir�im�gt, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Amusement Device License Application <br />� fF5 � I � f � <br />}3ut iness �l2i�it ? � 7L'A �.� �. .t+�'�.�'� ,r �lG � �ii �� �?�.r! .I�� � i�� � �J��k��f-'���J�',,t7� . -- _ <br />13iitintt§ .�JJrt~*h�, t� l �i �� I�! � ���• ~ � ' � � i. �_� ;_,� � F�`J �-� �� . � <br />Business Phone ��L�- � �Lv � � � �. �3 <br />Emai1 Address <br />f'��'so�e �+� �'.����+t� u� ��,�:�Y.f ; r� 8itrf�rrea�s �.i��eF�sre: <br />r�,� .� . � � r ��� �� � ��"�� <br />�d�r��s � �� �r�,�����. ��F ;��� ���fr� �. ����_�.. <br />J}�I{N�L ���f} J�_ } }� -- r� �f.•� � t�r�,�J <br />I hereby apply for the following liaense(s) for the term of one year, beginning July 1, ��� �_ and <br />ending June 30, ��4 •� .._ in the City of Ros�vi[l�, County of Ramsey, State of Minnesota. <br />License Required ' Ft� �������� ����� <br />Amusement Device <br />$15.00 ��� � �� <br />(per machine) <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and <br />regulation as the Council of the City of Roseville may Frc�ir� time to time prescribe, including Minnesota Statue <br />#176,182. .�--.� - f <br />, � � 4f� <br />,� <br />Signature �-.�[• ��� � T � � <br />�' ! <br />Date �� . .. ��'�� �. ' . . -- • - - -- <br />F <br />A fire Inspection is required before issuance of a license. Please call 651-792-7341 to set up an <br />inspection. <br />If completed license should be mail�ed somewhere other than t�l� business address, please advise. <br />�� <br />� �#�=�� � ��� � . � �' -�� <br />� � �,������ <br />�� �r��, �� � �� <br />� . .. � <br />_ r • �-.�+ <br />