Laserfiche WebLink
10"t k 4r-r'-! 1 7 T T - -T- <br />4Wj <br />if IL I -; I -j1t -j <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792 -7034 <br />Massage Therapy Establishment License Application <br />Business Name E�acc� A � � r <br />Business Address <br />Business Phone 62 5. 5reQ 30 <br />Email Address - - <br />Person to Contact in Regard to Business License: <br />Legal lea <br />me 1 <br />.6 -A <br />Address <br />Phone Date of B ir-th _ <br />Drivers License Number - <br />I hereby ap ly for the following licenses) for the terra of one year, beginning July 1, 42 C ; and ending <br />June 31, , in. the City of Roseville, County of Ramsey, and State of Minnesota. <br />License ReQ uired <br />Massage Therapy Establishment <br />Fee <br />$300.00 <br />$1 50.00 Background Cheek <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 City of Roseville may from time to time prescribe, including Minnesota Statue #176.182. In <br />addition, the applicant acknowledges that they are responsible for reviewing the background and work history of <br />their employees, including those that have received a rnassa a thera ist lieen�e from the <br />Signature <br />�j <br />Date 3 LAm <br />If completed license should be mailed somewhere other than the business address, please advise, <br />