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������ � � <br />� <br />City of Rosevii�e <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(6Sl)792-7436 <br />Gasoline Station License Application <br />$usii�ess Name <br />-Q-�� ---�-i .yc .. . ._ . .� <br />� <br />BusiFiess Address � �j �� �j � , � 3e v/}� �� � � J,�, , � � � <br />Business Pf�o�ie __ �� f � ���.' �j Z � Z �• <br />Email Address <br />Pe�soyt to Contact ir� Regard to Btrsincss Lrcesrsc: <br />{ L <br />�'ame _-�dtl�'1M �Ra�� I7 ' <br />;,- _._ .. ._ <br />•_� � -- <br />Address ` <br />Pl�one <br />I hereby apply for the following license(s) for t��e ternZ of one year, begi�tnrng� 1, .,ZdO �f , and <br />ei�ding �30, �`, in the City of Roseville, Cotn�ty pf Ra�i�sey, State of Mitineso�a, <br />Licen.se �ieqaired Fce <br />Gasoline Statian 5 ] 3Q06 <br />TFie ui�dersigned ap��licant iiiakes tl�is a�plication pursuant to al] t17e laws of the 5tate of Min�tesota and <br />regulation as the Counci] of tl�c City of Roseville may from Timc to ti���e prescriUe, including Min��esota Statue <br /># l 76.182. <br />Signature <br />Datc � O <br />A fire inspection is reauired befoi•e issuance oI a license Please cail 651-792-734� to set up an <br />inspecti.on. <br />]f completed ]icense sl�ould be mailed some�vhere other than the business add.ress, please advise. <br />�a�.'� �a -� �`� <br />13q� � 3'�s c . <br />� i �� �i M +v � 4 � � <br />