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2009_0629_Packet
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2009_0629_Packet
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1/9/2012 2:55:26 PM
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7/28/2009 2:46:41 PM
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1�.,�-,►�- � . __ J� J 1 <br />City oi Ras�ville <br />Finance Department, L�cense Divisior� <br />2660 Civic Center Drive, Raseville, MN.S5T13 <br />(65�) 792-7036 <br />Massage Therapy Establ�shmen� License Applicati�n <br />$usiness Nan�e <br />�3usiness Address <br />Business Phone <br />6mail Address <br />�--�-�---- - <br />Person tn Contact tn Regard to Busin�ss License: <br />Legal Name ���) . �%�� <br />Address <br />Phone <br />� �. � . <br />Drivers License Number <br />,� .. � . �th <br />I hereby apply for the �oliow'rng license(s) for th.e term of one year, beginning July 1, ��, and endir�g <br />Tune 3I, 1� , i�n the City of Roseville, Cnunry of Ramsey, and S[ate of Minnesota. <br />�c�t�se..Rer�si.�ccl <br />�Vlassage� Therapy Es[ablishment <br />Fee <br />$300.00 <br />$150.OQ Background Check <br />(new licens�e or�ly} <br />The undersignecl applicant makes this application ptirsuant ta aI[ �he laws af the State of 1Vfinnesota and regalation <br />as th.e Counc'rl of the City of Roseville may Erom time €o time prescri6e, inciuding iVlinnesota Statue #17b:182. � <br />addition, the applicant acknowl.ed es that they are respons.ibCe for reviewing the back�round and work history of <br />their employees, 'rnclucling ehose that have recei�ed a massa�e therapist iicense from the Citv. <br />5ignature <br />Date � � � <br />If cornpleted license sh.ould be mailed son�ewhere other than. the business address, please advise. <br />
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