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13�;�i�c�� � �i,�,^ <br />134181fF�55 }5y:2.�f48S <br />� si,�nir��. f��.a�� <br />E�»ail Address <br />��� ��'� .�' Y�� <br />��� � . r�� � � <br />City of Roscville <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 � fi <br />�� �Ll t..�: �� hDl� � �j �- <br />� � � �� ����`� �' � <br />Yerson I o Co��tacl rr: Regm°d to Business License <br />Name ������I��._ }.���f��-6� — <br />i.�res� f� �� �i�':���f �4xt��, �] � <br />._ „� <br />:�i_,�,._ f�. ���. -,�.�' �� ;� � <br />I liereby apply for tlie following license(s} far the term of one year, beginning July f,� a�� �� , and <br />ending June 30, �• t'i� •� , in the City of Roseville, County of Ranisey, State of Ntinnesota. <br />License Required <br />Amusement Device <br />F e.e <br />$15.00 <br />(per �nachi�m} <br />uantit ' �o�:�� <br />f.� _� } -- <br />The undersigned applicai�t malces diis application pursua�lt to all the laws of the State of Mimlesota and <br />regulation as the Council of the City of Roseville �11ay from ti�ne to Si;.it prescribe, including Miiulesota StaCUe <br />#176,182 <br />�� � ~._:�... �_�•} <br />�� � iy�iLui t �+-� <br />�11SL �r'�~� � <br />A fire Inspection is required before issuaiice� of a license. Please call 651-792-7341 to set up an <br />inspection. <br />If completed license should be �nailed so��t�ewl7ere other dlan the business address, please advise <br />