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1��� <br />City of Roseville <br />Finance Department, Lice�nse Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(CS�.) 792-7036 <br />Massage T`herapy Es�ablishment �icense Application <br />, �� �G� <br />Business Name C` /-` <br />$usiness Address <br />5� r/I -- �d� �� .� <br />., J - <br />Business Pl�one L� S �D � �° �� G <br />� � � r I <br />Email Address <br />Person to Contnct in Regarcl to Business L.i.cense: <br />�.egal Name ��2 � C r' �� � 4/1� <br />-� �� <br />Address � <br />Phone <br />Drivers Lieense Number � <br />I hereby a ply for ihe folEowing license(s) for th.e terRl of one year, begin��ing July 1, � , aad ending <br />Jnne 31, ��—, in the Ciry of Roseville, Counry of Rar�-isey, and 5tate af Minnesota. <br />�ir.cuse-Ae�si�ed <br />Massage Th.erapy Esiablishment <br />Fe.c <br />$300..00 <br />$150.00 Background Chec[c <br />(new license only} <br />The e�ndersigned apPlicant m.akes this application pursuant Eo all the laws of the State of Minnesata and reguEation <br />as the Council of the Ciry af Roseville rrsay from time to time prescribe, including Minnesota Statue #I76.182. I� <br />add�tion, the app[icant acknowled�es [hat [hey are,res�onsible far reviewin� the backgro�nd and work historv of <br />their. emplovees, includina those that have received a massaQe iherani�r 1�r���P ����» rhP r'rr�, � <br />Signature <br />Date � f�Z - � / <br />Ii completed license sh.ould he mailed somewhere �ther th�.n the 6usiness address; please advise. <br />