Laserfiche WebLink
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 Narne ell� 5 �--z <br />Business A.d.dress lz� <br />Business Phone G�� /' 3.,2 % — ;��5� <br />Email Address - - <br />Person to Contact in Regard to Business License: <br />Legal m � C 17.1; /.-�z <br />e� Name e <br />Address <br />Phone <br />Drivers License lumber <br />I hereby apply for the following l icense(s) for the term of one year, beginning July 1, � } and ending <br />June 3 1,. } in the City of Roseville} Counter of Ramsey, and State of Minnesota. <br />License Required. Fee <br />ww ^wwwwww-w w� rr.a�r <br />Massage Therapy Establishment $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 Counei -I of the City of Roseville may from time to tirne prescribe, including Minnesota Statue #176.1$2: In <br />addition, the applicant acknowledges edges that they are responsible for revie i ur the .baekgrou nd and work history of <br />their employees, including those that have received a massage therapist license from the <br />Signature <br />Date 4,f,� W <br />If completed license should he mailed somewhere other than the business address, please advise. <br />