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Amusement De - e License Application <br />MOMISVtEw <br />24p1 Mounds View Boulevard . Mounds View MN 55112-1499 <br />(763) 717-4DOo ' Fax (763) 717-4019 <br />info@moundsviewrnn.org ' WW W. moundsviEwmn.Qr <br />Wounds View License Address: <br />Email Appfiratidn <br />Business License Application fate; <br />Business License COU NCIL Approval Date: <br />❑ NEW APPLICATION <br />RENEWAL APPLICATION <br />Corporation Name: dean Superior Vanding Co. <br />Corporation Address: �3�3 E.� <br />E. <br />Phone Number: <br />612-721-3393 <br />City: Minneapolis <br />State: z;p:55406 <br />Fax Number:N/A <br />Email address- scot#.deanXZZadeanvend ing.cflm <br />DBA (Doing Business As); <br />OwnerslCorporate Officers/Partners (name and title): <br />I Scott Dean, President <br />2.8hawn Dean, vice President <br />3. <br />4. <br />5. <br />Application • <br />Applicant Name:SCOtt Dean <br />Applicant Address.14367 Starr►nrood Circle <br />Phone Number' <br />612-290-9652 <br />City: State: Prairie i state:MN lip=55347 <br />Fax Number:N/A <br />Email addresssCott.dean@deanvending.com <br />*i hereby certify that the information provided I this application is true and correct and I understated that any misrepresentation <br />made herein ma be rounds for denial of this a plication for a business license, <br />*Applicant Signature: r <br />min <br />•- <br />Amusement DeviceslCenrer <br />❑ Gasoline Station <br />intoxicating Liquor" <br />Additional Form —Appendix A) <br />Adult Establishment <br /># of Pumps <br /># of Gas Storage Tanks <br />5 <br />3.2 Percent Malt Liquor — <br />PeddlerlSoliciterlTransient merchant <br />❑ Automobile Safes <br />❑ Boviding Ailey <br />'Annual Fire Inspection <br />❑ Recuperative HornesfHalf Way <br />TattoofPiercing)Psinting <br />Therapeutic Massage <br />Number of Lanes <br />❑ Cigarette and 7obacco'(CT102 MN <br />House <br />❑ Pawn Shop <br />Christmas Tree Sates <br />Garbage/Recycling <br />Dept of Revenue Form -City Sends) <br />[] Lawful Gambling' <br />Over the Counter Sates <br />❑ Restaurant' (copy of Ramsey <br />"Require <br />copy of Ramsey County license. <br /># of Vending Machines <br />'Annual Fire inspection <br />County Food License Required) <br />"State of MN Requirements must be met. <br />❑ Circus/Camivais/Rides <br />occupancy Load <br />a# of Hour Open Per Day <br />❑ Donation/Collection Bin <br />Class A Class B <br />'lave you ever had a license revoked? YesiNo If Yes, Please attach explanation- <br />JFFECE USE ONLY: Police hieE Approved/Denied {circle one <br />Receipt #: <br />Notes: <br />Comments: <br />Fee $ (checkJcashlcc ] <br />Date of Payment <br />