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Email Application <br />MOUNDS VIEW <br />2401 Mounds View Boulevard * Mounds View MN 55112-1499 <br />763) 717-4000 * Fax (763) 717-4019 <br />Barb. beneschCa)mou ndsviewmn.org * www.moundsviewmn.org <br />Business License Application Date: <br />Business License COUNCIL Approval Date: <br />NEW APPLICATION <br />RENEWAL APPLICATION <br />BUSINESS <br />Mounds view License Address: <br />2213 Mounds View Blvd, Mounds View, MN 55112 <br />Company <br />Corporation Name: Mounds View Chicken, LLC <br />Corporation Address:100 Menlo Park Mall, Suite 500 <br />Phone Number: <br />732-895-8936 <br />City: Edison <br />State: <br />NJ Zip: 08837 <br />Fax Number: <br />Email address: <br />krupa.modi@pnrestaurants.com <br />DBA (Doing Business As): Popeyes <br />Owners/Corporate Officers/Partners (name and title): <br />1. Amish Parikh / Partner <br />2. Ashish Parikh / Partner <br />3. <br />4. <br />5. <br />A..address) <br />Applicant Name: Suzanne Bradley <br />Applicant Address: <br />100 Menlo Park Mall, Suite 500 <br />Phone Number: <br />404-849-4312 <br />City: Edison <br />State: <br />NJ Zip: 08837 <br />Fax Number: <br />Email addresssuzanne.bradley@pnrestaurants.com <br />1 hereby certify that the information provided I this application is true and correct and I understand that any misrepresentation <br />made herein may be grounds for denial of this application for a business license. <br />Applicant Signature: <br />TYPE OF DIFFERENT FORM REQUIREDFOR: <br />Adult Establishment Gasoline Station Intoxicating Liquor" <br />Automobile Sales of Pumps 3.2 Percent Malt Liquor — <br />Bowling Alley of Gas Storage Tanks Amusement Devices/Center <br />Number of Lanes Recuperative Homes/Half Way Peddler/Solicitor/Transient Merchant <br />Cigarette and Tobacco" House Tattoo/Piercing/Painting <br />Over the Counter Sales Pawn Shop Therapeutic Massage <br />of Vending Machines Lawful Gambling" Christmas Tree Sales <br />Circus/Carnivals/Rides Restaurant* <br />Donation/Collection Bin Occupancy Load 40 Require copy of Ramsey County license. <br />ri Garbage/Recycling of Hour Open Per Day111/2-12 <br />State of MN Requirements must be met. <br />Class A x Class B xxx <br />pleaseHaveyoueverhadalicenserevoked? Yes/No If yes, <br />OFFICE USE ONLY: <br />Receipt # Police Chief: Approved/Denied (circle one) Notes: <br />Fee $ (check/cash/cc ) Comments: <br />Date of Payment