Every applicant for a license required by this chapter shall file with the Director of Finance a written application stating the full name and address, including the street number of the applicant, or if the applicant is more than one person or is a partnership or corporation, the full names of all parties interested and their addresses, including street numbers. If the applicant is a club, society or corporation, the application shall contain a complete list of the managerial and executive officers of such club, society or corporation, with their names and addresses, and if a corporation, the application shall give the name of the state in which such corporation is organized. The applicant shall also state the following:
(a) The premises where the juke box is to be operated, placed or maintained, including the street number;
(b) The age of the applicant or person in charge of the place where such juke box is placed and maintained; and
(c) The name of the owner of the premises in which such juke box is located and the complete address of the owner.