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2461 Mounds View Boulevard ' Mounds View MN 55112-1499 <br />(7631717-4000 - Fax V93) 7174019 <br />Sarb tteneseh I oundsviewmn o ' v W6&Moundsvkmnn.dru <br />Business License Application Date: J— -„1 .:2 j <br />Business License COUNCIL Approval Date: <br />E�( NEW APPLIGAmoN <br />❑ RENEWAL APPLICATION <br />BUSINESS <br />APPLICATION <br />Mounds Ytew License Address: <br />Company Information <br />Corporation Name: <br />Corporation Address: <br />Z 3 Y5 c014,n t <br />Rat h' z <br />¢ Phone Number_ <br />City- <br />State. <br />V <br />Zip: r <br />� <br />Fax Number: <br />f%Li%�Grf 1/1 _ fx/ <br />iK 1 <br />( <br />Email address: <br />DBA (Doing Business As): <br />�t <br />b� <br />S r-e- a Qe <br />5 <br />Owners/Corporate Officers/Partners (name and title): <br />i '�- <br />2. <br />............ <br />4. <br />5_ <br />Applicant information, (renewal <br />Applicant Name <br />: (7 <br />+4PP <br />Applicant Address:. .. <br />Cowl <br />e- j Y Z <br />`Phone.. Number: <br />( -- i S <br />Cit)r <br />V` Ov U'ie�n� <br />State: <br />Zip: <br />f z-, <br />Fax Number; <br />3 <br />Email address ! <br />.� `NV O—r, <br />C-01-- "� <br />*1 hereby certify that the information provided I <br />IS application is true and correct and I understand that any misrepresentation <br />made herein may be grounds for denial of this <br />2,okfication for a business license. <br />-� <br />`AppllcantSlgnaty. ,TYPE <br />OF L�CENSE APPLYING <br />FOR: DIFFERENT <br />FORM REQUIRED FOR, <br />Adult Establishment ❑ <br />Gasoline Station <br />Intoxicatirtg Lkluor— <br />Automobile Sales <br />* of Pumps— <br />3.2 Percent.MlaVt Liquor' <br />Bing Alley <br /># of Gas Stowage Tanlca......... <br />Amusement DevicesfCenter <br />Number of Lanes <br />Cigarette and - <br />Recuperative Hornaslt#alfway <br />House <br />PeddlerlSolic WrFransient Merchant <br />.Tobsom <br />Over the Counter Sales <br />Pawn Shop <br />TaiboolRercinglPainting <br />Therapeutic Massage <br /># of Vending N ladtiuties <br />LSWU Goff6kq+- <br />Christmas Tree Sates <br />❑ CesusiCamivalslRides <br />Relfturanf <br />OonationfUollect on Bin <br />pancy Load recopy <br />Occupancy <br />eRamsey County. license. <br />GarbagelRecyciing` <br />—Stet <br /># of Hour Open Per Day e <br />of MN Requirements must t met. <br />IHave <br />Class A Class B <br />you ever - . <br />OFFICE USE ONLY_ <br />yes. Wease attach explanation. <br />Receipt # Police Chief: ApprovedWenied (cirde one) <br />> ee $ wwish(CC Comments: <br />Date of ant <br />Notes. <br />