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� <br />T <br />��� <br />��� � <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 />Business Name ���•�� `���,� � <br />BusinessAddress ��,�✓� l�V, ���,€� ���-�� ��� '����,���f�,��l/,� <br />Business Phone [ �D �� � � / —,� �/.�� <br />Er��ail Address ..._ <br />u <br />Person to Contact rn Regard to Business License <br />� �ir_� <br />•r <br />Address +��,�'� ., �.�. � L�� � �{� <br />Plio��e � � ��_ �� �"��_ _ <br />1 hereby apply for the following licei�se(s) for the tenn of one year, begnining July l, �-4(� �, and <br />ending 7une 30, ��?� Co , in the City of Roseville, Cou:�ty of Ramsey, State of Minnesota. <br />License Required Eee uanfit '1'���1 <br />Amusement Device $15.00 � '�J.�'� <br />(per machiae} <br />The undersigned applicant makes this application pursuant to all the laws of the State of Minnesata and <br />regulation as the Council of the City of Roseville may from time to time prescribe, nlcludii�g Minnesota Statue <br />#i'�6.182. � .� <br />Sigiiai��re �I� ��fY�1� <br />� �a7iL J��CO�f1�Rt <br />Date O.— �„ _ ��-$C��$qg4 <br />A fire Inspection is reauired before issuance of a license. Please ca11651-792-7341 to set un an <br />mspection. <br />If completed liceiise should be mailed somewl-�ere other than the busi��ass address, please advise. <br />