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Business Name <br />Business Address <br />Business Phone <br />Emai1 Address <br />� <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 />:��� /�F���,���� <br />� �{':x f i�� �'r'��r',4f��t� �r��- <br />��r� ��G�•-���� <br />��r�Vkf� <br />Person to Contact in Regard to Business License: <br />�x��f:11C� <br />r�i{iti1=��$ <br />_��� �i=��'.�t� �� <br />��+� ��_,__��7��� •'*"'��� ��� <br />Phone �4 /-�`�� ^- <br />1 hereby apply for the following iicense(s) for the term of one year, beginning July l, ��' �� , and <br />ending June 30, �-�'� � , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Reauired <br />Ainuseir�et�t Device <br />Fee <br />$15.00 <br />(perrnachine} <br />uantit <br />r} <br />Total <br />,°y �, �y�� <br />� <br />The u�idersigned 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 niay from time to �irne prescribe, including Minnesota Statue <br />�176.182. <br />�ig�ttirc <br />I�rrc <br />� <br />.:���. <br />����. ���� <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 mailed somewhere other tl�an the business address, please advise. <br />� <br />� <br />� <br />