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City ol"Roseville <br />Finance Impartment, License Di i" v isil loin <br />,216'160 Civic Center Drive, Roseville, MN 55113 <br />(651) 7912-170314 <br />r M.#f 111'pm M-1 ffm <br />Busineiss, Name Tr- VA r(,IX cOV 110"A <br />Business Address 23-) X/ Cgr 5T, le t't 2r0le <br />Business Phone U/ -S- / — jP 0 4P , Y/, Y <br />Email Address <br />Persian to Co tacit iin,Rliega,rd' to Business License: <br />LIMMUM <br />Address <br />Phionle <br />Drivers Liciensile Number <br />I herebly apply for the following license(s) for the term of one year,, belginning MY 1, and ending <br />June 3 1, 26rd,,;� in the City of Roseville, County of Rarnsie , and, State of Minnesota. <br />Y <br />,License Required <br />Massage Therapy Establishment <br />Fee <br />$3,100.100 <br />$1150.00 Background Check <br />(new license only) <br />The undersigined app icon makes this application pursuant to, all the laws of thile State of'Minniesot,a and regulation <br />as the Ciounci' I of I the City of Roseville may from timeto time, prescribe, inclining Minniesiotia Stiatule #176. 182., In <br />aididition. the am)ticant acknol'Wledves that thev are resi)onsi'bile for revilewine, the backarounid, and work histor'V Of <br />their qmplioy ens , including these that have received a rnas5Age them pist'liciensle from the f it <br />S in aura <br />Date <br />If com leted 11"icensile should be mailed somewhere other'ffi,an thebusliness, aididress please advise. <br />p I ' <br />