Laserfiche WebLink
i"'� <br />� ""�;'��� "-� <br />-� <br />���� � � � <br />Ci#y Qf Raseviile <br />�'��anc� Depar�ment, License Division <br />2660 Civic Center Drive, Roseville, MN 551� 3 <br />(651} 792-7034 <br />Massage Therapy E�tab��shr�enf LYCen�e App�ica�iion <br />Business Name % f�} C� v� � 'V' S� <br />CJ ��.. . <br />Busir€es5 Address <br />�3usiness T'ho�ie � �"=�- -� � d'� �"._ � 2s <br />j.. � __.. . � � . __ <br />�ma�l �ddress � <br />— �; � <br />Fe�son 8o Contact in Regard to Business License: <br />�.ega[ Name ��"_' --��E? �" � 1� 1% �... C. � G V� �.,5 <br />Address <br />�`hone ,, � -. j Iaate of �i►t� _ � � .� <br />Drivers I,icei�se Nurnber <br />I hereby apply f4r the followzn� license(s) for the terrra o� one year, beginning 7uly l, 7� ~'� , and end'ang June <br />31, 7� �. �, in the City of �2osevilte, County of �Zams�y, Stsie of Minnasota. <br />Z,'rcense Rectuired �'ee <br />Massage Therapy Establzs�mea�t $300.00 <br />$150.00 I3ackground ChecJc <br />{new ficense only) <br />'x`he undersignecl applicanf �nakes this application pursuant to aI3 the [avvs of the Stat� af Minzxesata and reg�latio�� as <br />the Cnunci[ of tl�e City nf Raseville �nay from time ta time prescribe, includir�g Minn ta Statue #] 76.182. <br />.""",�� f...-.- <br />Signature �.��f „� ✓ <br />.�-' <br />D��� � r.��r, � <br />T�'cqrnpleted license sliould be maiEed sqrnewheyc ofi�er than ihe business address, please advise. <br />