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. �p(1• <br />P "1N <br />CITY OF NEW BRIGHTON <br />803 Old Highway 8 NW <br />NEW BRIGHTON, MN 55112 <br />-� <br />(651) 638 -2050 <br />www.newbrightonmmeov a– 17-1 6 <br />2014 BUSINESS LICENSE APPLICATION <br />Applications must be completed in full. Middle initial or name is required of all parties concerned. If no middle name, please indicate by writing NMN. Sign and return <br />application with the appropriate fee. Please advice the City of any change in status Anew license is required if a business changes location or ownership. Notification to <br />die Cin• of New Briehton is required if the business closes. <br />Business Name: <br />Business Location: qM0 GDgnl kE 1 4CrrQ W SJ l � W �� yy! M(] 155t <br />t2 <br />Facility Phone: 24 hr Phonie)Facility Fax: <br />Mailing Address:11b> l L I S ( Sl h� jk <br />(if different than above) <br />City. State: myd <br />j <br />zip:. SS3(N <br />Enter Below Names of Owners, Partners or Co rate Officers – Use Additional Sheets As Necessary <br />Ownership: E�,Corporation ❑ Ltd Liability Corp ❑ Partnership ❑ Ltd Partnership ❑ Sole Proprietor ❑ Trust <br />Owner /Corp. Name: IJCi,i 11�1t attiYcx�ti,� � � Title: R _Sj ta� Phone: (�12 –u�1 111 <br />Home Address: Cell: b12 —i I_ a t I <br />City:rvA�r_t State: Mtv Zip: SS 7'C', j <br />Email: vi rho 1 , c5hr. r CD t_ Cf,.� Driver's License No. :s t. 1 '1 L\ : m t?r <br />Minnesota Tax ID or Federal Tax ID or Social Security No. (Required) <br />Owner /Corp. Name: Title: Phone: <br />Home Address: Cell: <br />City: State: Zip: <br />Emai I: Driver's Li�ense No. <br />Minnesota Tax ID or Federal Tax ID or Social Securi No. (Required) <br />Enter Alarm Company ifApplicable) <br />Name: n Title: <br />Address: License No.: <br />City: State: Zip: <br />Flammable or Hazardous Materials Used or Stored on Premises? ❑ Yes o I es, lease provide list of materials & quantities <br />Pleme check the i n e s for which h e Annfitation ks beine mode. Please note thc li nse are c to oriz d lbv I <br />icemine neriod. <br />January I through December 31 <br />Equipment Rental <br />$220.00 <br />New Cars <br />$220.00 <br />Used Cars <br />$220.00 <br />April 1 through March 31 <br />Amusement Center <br />$1,785.00 <br />Electronic Game or Device Number of games: <br />$19.00 /game <br />Garbage & Recycler Haulers: Please check what type you service: Commercial Residential <br />5275.00 <br />3.2 Percent Malt Liquor— On Sale <br />$347.00 <br />3.2 Percent Malt Liquor— Off Sale <br />$155.00 <br />3.2 Percent Malt Liquor— Off Sale Temporary <br />$102.00 <br />Drink Set -Up <br />5435.00 <br />Tobacco Sales <br />$320.00 <br />Jane 1 throe h May 31 <br />Gasoline # of Pumps <br />$240.00 <br />30 Day Licenser <br />Christmas Trees <br />$87.00 <br />+ Total Amount Submitted <br />$ <br />