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City of Roseville <br />01 <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 7912-7036 <br />Massage, Therapy Establishment License Application <br />PIMMI <br />- --------- <br />Business Name <br />n <br />Business Address 4tf"') C" .5., , ;4e <br />Phone Ij <br />"JAWL <br />Drivers License Number <br />A,;,!.• V <br />I hereby apply for the foillow,ing licenses for the term of one year, beginning J41y-1, and ending <br />June 3 1 1 916,q -I in the City of Roseville, County of Ramsey, and State of Minnesota. <br />Massage Therapy Establ' <br />shment $300.00 <br />$150.00 Background Check <br />(new license only) <br />The, undersigned applicant makes this application pursuant to all the laws of the State of Minnesota and regulation <br />as, the Council of the C,ity of Roseville may from time to time prescribe,' Includin"Minnesota Statue #176.182. in <br />aidd*ti I, the a,p t acknowled <br />1 0 plican ges that they are reWonsible for re�view 9'ackizround and work hist <br />their employees, including those that have received a massage therapist license from the <br />Signature <br />Date � 7 � Ca <br />lUcompleted license should be mailed somewhere other than the business address, please advise. <br />