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<br />, <br />.. <br /> <br />> <br /> <br />CITY OF LITTLl! CAmIDA <br />APPLICATION fOR. MASSAGE THERAPY ESTABLISHMENT LICENSE <br />(Must be accessory or incidental to properly zoned beauty salon.) <br /> <br />License Fee - $100.00 <br /> <br />NEW <br /> <br />RENEWAL <br /> <br />Please complete the fOllowing. If the application is by a <br />natural person, by such person; if by a corporation, by an <br />officer thereof; it by a partnership, by One of the partners; if <br />by an unincorporated assooiation, by the manager of managing <br />officer thereof. <br /> <br />1. Name of Applicant (name Of individual, partnership, <br />corporation, or association): <br /> <br />(If Indiviaual) LAST <br /> <br />FIRST <br /> <br />FULl. MIDDLE NAME <br /> <br />2. Na11le of Beautv Salon under which applicant wi 11 be doing <br />business, ousiness address, and telephone number: <br /> <br />Full Name <br /> <br />Business Address <br /> <br />Business Telephone <br /> <br />3. Type of Applicant: <br /> <br />___Individual <br /> <br />_____partnership <br /> <br />_____Corporation <br /> <br />Association <br /> <br />other <br /> <br />4. A. If applicant is an individual: <br /> <br />Name <br />LAST <br /> <br />FIRST <br /> <br />FULL MIDDLE NAME <br /> <br />Date or B1rth <br /> <br />Residence Add~e5s <br /> <br />Residence T~lephone <br />Business Address <br /> <br />Business Telephone <br />social seCUrity Number <br /> <br />Driver's License Number <br /> <br />1 <br /> <br />GO 'J <br /> <br />\lEg\7\7\l\7199 'ON X\!,J <br /> <br />\!G\!N\!O ~11111 jO ALIa <br /> <br />12:\71 NOW 10-92-H\!W <br />