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l� <br />.� <br />City of Roseville <br />Finance Department, License Division <br />2(60 Civic Center Drive, Raseville, M1V 55113 <br />{b51) 792-7034 <br />Massage Therapy Establishment License Applica�io� <br />BusinessName ���''Y�iCci�j ����v"� "I [ � ���C�''e 0,_,/� � (�L.�t.�� �-p-r,��•�;� <br />Busi.ness Address �C�2� { /if25�� <br />.. . <br />Business Phone <br />� I2�� -f�� <br />Emai! Address _ - <br />Person ta Contact irr Regard to Business Lrcense: <br />Legal Name {!t � � �� � <br />Address <br />D G'� <br />��e-JZ �[,e , ��1� �� S`�(1� <br />D� <br />AI,Lr� V4�— �6 <br />p}���e � f� v��4 Date ofBirthu <br />Drivers License Nurrtber _ _ <br />� �� , (� (� .5�r� <br />_ r . . . <br />r� <br />I hereby apply for `'-e foflowing license(s) £or the term of one year, beginning July 3, ��� and ending <br />Jur�e 31, �� _, in the City of Roseviile, County of Ramsey�nd State of Minnesota. <br />Li.cer�se Required <br />Massag� Therapy �sta.6lishment <br />Fee <br />� <br />$15Q.00 Backgrour�d Check <br />(new iicense only) <br />Tf�� undersigned applicant makes this appiica�ion pursuant ta a11 the (aws of the State of Minnesota and regu[ation <br />as the Counci[ of the City oi Roseviile may fram time to time prescri.be, �ncluding Minnesota Stat�e # 175.182In <br />ar�r{itinn the an��icant acknowledEes that thev are responsi6fe for re�iewin� the b_a_ck�rou�d and work history oi <br />\� +' � � <br />Signature �S./ y� <br />�ate �' � � �` � C� �` <br />r <br />If campteted Iicense sf�ould be mailed somewhere at�er than the business address, ptease advise. <br />