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�`� � � ir <br />Cify of R�seviile <br />Fia�ance D�par�m�nt, License �.?ivisio� <br />�660 �ivic Cen�er D�xve, RoseviYle, Ml� �5113 <br />{�Sl} i"9�-7�34 <br />�t�Ia�sage T�e�°��� 1Es�ab��s��e�.� ��cense Appl�ca�zon <br />Business Name <br />Bttsiness Address � 11�--�� • r�b " �-Q� ' � <br />Business P��►one <br />E�nail Address <br />� <br />�� 1 ~~ � --� � a �� 10 � <br />� "� � ��� <br />Ferson to Contact in Regard to Business Licen.se: <br />Legal Nacne ��.�.�Y���.. . <br />Address � � C? . s 5����-- �P���- �.fn4� Ct~�-t, � �-' � 1 `�� �C� � ��7c �� SL`� �J"w <br />i <br />i'h�ne ��- � "` ` <br />Drivers Licens� N�mbP� � � � - � ' `' �� - <br />Date of Birth <br />I heraby apply far �he foilowi��g lice��se(s) �or the terrzz af or�e year, begiiti3ing 7uly 1, .2v0 Y7 , and �nding <br />Ju��e 31, � pog , in il�e City of Roseville, Caunty af Rainsey�nd State of Min�l�snta. <br />License Repuired <br />N�assage T�€erapy Establishrnent <br />Fee <br />$300.00 <br />$I50.00 Background Check <br />(ne« lic�nse or.i�>) <br />T�e unc�ersig�ed ap�alicant n�akes tllis application purs�ant to all il�e laws of the State of Miniaeso�a and regulation <br />as ihe C�uncil afthe City of Ros�va�te znay f'ro��€ �irrce fo tizne p,rescr�be, z��c�udzng Minnesota Sta�r�e ��76. �&2Zr� <br />addition, the ap�licant acknowledg;es ihat ��ey are responsible #'or reviewing ths back�;rot�nd and work histor�o� <br />Signature <br />Date �,�° ��`' � � <br />�f cornpleted lice�se shouid i�e mailed somewher� oiher th�n the business address, please advise. <br />