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� ��� � � ��' ����� <br />d <br />r j� 4 �� � ; p��_�,� `' � �.�� � � <br />� � � � �� ,� D ,� � o� <br />��,� � y-�' �-f ,.�� �� ��'• <br />-��� ���.���., <br />�� �� <br />��i �'� ���, ���/'� � City of Rosev�lle <br />`. f i :N � � <br />. E,� � �! �.e, '/ Finance llepartment, L�cense Div�s�on <br />�� �0 �D � 26b0 Civic Cent�r Drive, Raseville, MN 55113 <br />` 5 r (651) 792-7036 <br />v <br />Massage Therapy Establishment License Application <br />Business Name �" ���'/ � ��`�%/ ���/ �/ ��`-� <br />Business Address �� �j /� r �'/���.�� ��� � � Uf 1 � ��-�� <br />Business Pho€te l /_ .�� ��� � ��8� t <br />EmaiE Address <br />Pcrson to Contact in Regard ta Business Licerzse: <br />. /J �r! :� 7 /7 . �- � �...-- <br />Legal Naine ,� <br />Address <br />Phone <br />D3ivers Licens� Numbe�� �, <br />.�/�-��/� <br />] hereby apply for Ehe following license(s) for Ehe term of one year, beginning July l, r�0� ., and ending <br />June 3] ,�, in the City of Roseville, County of Ramsey, and State of Minnesota. <br />�,ice�se iRec�� �ee <br />Massage Therapy Estab�ishment $300.00 <br />$ i 50.00 Bac[cground Check <br />(new license anly) <br />The undersigned applicant makes this application pursuant to all the ]aws of the State of Nlinnesota and regulation <br />as the Council of the City of Raseville may from time to time prescribe, incluc�ing Minnesota Statue #176.182. � <br />addition the applicant ack.nowledges that they are responsib3e for rev�ewin� the bacEcground and. worfc histo_ry af <br />their em lo ees includin those that have received a massa e thera ist ]icense fram ti�e CiE .. <br />Signature -�/,� �'/� <br />. r� <br />Date s � .� � <br />� <br />If completed license shouid be n�ailed somewhere ather th.an the business address, please advise. <br />�.�' ,�;� .�!✓ r�/�i <br />� �l���= �D ��,l�i�.d � � � � SD �/y � ��� So ��� �!T ,�lSC; <br />� � <br />�/� ����= �°��'�,�,�1 � ��r�?l�CTr�,,�� .�%/��,� -��=�=i�,c�, G��'�� /� <br />��-� ��'�i c-✓� cf-W:.� �.. s,��'� �G�i� ,�/sc .�f'�",�/,f !�/r�,� SG,�f�%.�=d� <br />