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City of Roseville <br />Finance Department, License Division <br />* 4% <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />bUshment License Application <br />Massage '.'fherapy Esta i <br />RIM <br />Bus�inesis Address <br />Email Address <br />Person to, Contact in' Regard to Business License: <br />Legal Name, L - I LL 0-4 <br />Address <br />ARM <br />Date, of Bixth.,--- <br />Massage Therapy Establishment <br />$3iOOi.00 <br />$150i.,00 Backgrolu,nd Check <br />(new license only), <br />The undersigned applicant, makes this appfication, pursuant, to all the laws of the State of Minnesota and =gulation <br />ell nnesota Statue #176.182. la <br />as the Council of' the City of Roseville may from, time to time, orescrib y includin M,i <br />'§ac' and work <br />they are xes tewing. ht. ...kgrou,nd history of <br />ajapl "'cant -a6knoAled es that Rgn,s,iblefor rey" <br />addhi!Qjl:it� gi <br />their emploges.- ins cludinzthose that have received a massaae therapist license from the C <br />Signature W <br />Date <br />if completed license should be mailed somewhere other than the business address) please advise, <br />I .. 1. N 3 6�i )� �'��en <br />Tn & OL <br />W1 <br />131win�n , 1��J SS��� . <br />11 1 'AM& � j I <br />