Laserfiche WebLink
1 ����. � � � <br />�_ <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55ll3 <br />(651)792-7034 <br />Amusement Device License Application <br />�'•� { �' - r <br />/ � I <br />BusinessNan�e r� *�- � �' ` ���G�� _._ __ <br />Business Address <br />Business Phone <br />�mait Address <br />r � ��� �r <br />_.�-=� � � <br />��---���� ��.-.�?:��_ <br />�F ''�dN l.{49i(:L': UF �4tl4Yir,:� 1�� �S'2h{n,R� � Y5� <br />� _ �� ' <br />� x T� <br />^.�f�PtC� ,.����� - �'d� - -•• -- ••— ---•----- - —••—•------ <br />Phone <br />I hereby apply for the �c��lt?5�; ���- ��cense(s} for the terr� of one year, begizuiing July 1, ,`�`� �`�'���� <br />ending June 30, ����, •�i7 the City of Roseville, County of Ra�nsey, State of Mi��esota. <br />License Required Fr� �a�n�l# � Toi�E <br />,Flrnusen�ent Device $15.00 _� , _ �.��,�` � <br />(per machinc) <br />The undersigned applicant malces t�aas application pursuant to all the laws of the State of Miiv-iesota and <br />regulation as the Council of the City of Roseville may from time to t€��e prescribe, including Mimtesota Statue <br />�2?f.LE-. <br />� ��__ } � � <br />Signature ,,��� � <br />Date ��� �,���� ''"��'�� —, — -, <br />A fire �nsQectfon is required before issuance of a license. Please ca11651-792-7341 to set up an <br />insqection. <br />If completed license should be mailed somewhere other than the business address, please advise. <br />