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2007_1022_Packet
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2007_1022_Packet
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Last modified
1/10/2012 12:42:12 PM
Creation date
8/26/2009 2:57:48 PM
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Roseville City Council
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Council Agenda/Packets
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.��� `� - � . � _ "� <br />__ �� <br />�'i��n�� i��p��m�n�, Lf���ns� D°avi���� <br />2G64 ���� ���i��° ����4 �to����ll�� �5� �3 <br />�651� i92-7034 <br />ass��e �'her��ist I��ce�se <br />New License Ra�e�wal � <br />�nr License ysar er�ding Iune 30, 200� <br />1. Lega1 �Va�r�e: �a ��e Ce ��ll <br />2. Home Address: ` <br />3. Hwme Teiephone: . <br />4. �ate of �irtri: <br />5. Drivers License Number " <br />&. Emaii Add�ess: <br />'7. Have you ever used or bee� �nown by any nanr�� other thai� tl�e legal �aaxae give� i� nurnber l above? <br />Yes _ � No Tf yes,list each name atong with dates and places where used. <br />8. Name and address af ��e lic�ns�d Massage T�ecapy Esta.blis�arne:nt tt�at you expeci io be eamploy�d by. <br />��p�a �����. it�ss��� %.�.0 19G�_��e �� ��s��n��e9 � 5�11� ��aa�� #29�� <br />9. Attach a certified cop� o£ a c�iplaz�a or eerti�cate of grad�zatzon fro�n a school of �nassage th�rapy <br />i�cluding a xrtinzxn��:t o�6QQ taours in succ�ssfirliy eo�pleted course work as described in Raseville <br />Ordinance 1 �6, anassage T��ra�y �sfablis�men�s. <br />10. Have vou had a�y previo�as nr�assag� th�;zapzst license that was revoked, susgended, or no� renewed? <br />Yes� No If yes explain i� detail. <br />License fee is 75.QQ <br />�a�e c�ecics payable to City afk�mseville <br />
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