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2006_0522_Packet
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2006_0522_Packet
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� ��� � .� <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651)792-7034 <br />Massage Therapy Establishment License Application <br />, �- - � <br />t � � �.: �, <br />Business Name _ _, j �� 5�� ��''t�_.. .��� ���'�5��� � �-.��,���� � - �� i�' 1� 1� L � ��'� <br />i k <br />Business Address � � � � ����� ry � y I y�����:� � r� � ',4 ���,� <br />Business Phone _ I����f _ ����� _ , _, ,__ _ _ _ <br />L-ru:Li= l�.sGjlus <br />Pe�sarz to Contacl in �te�ard to Business License.� <br />ti i 1•-�� <br />I � ti � <br />Legal Name � ����1;�� � �4� �,. �. <br />� <br />aaaress . � _. _'�-: ����"-y''4ti� � i �� 4 f ��� . �� — . ������ . . _ � .. ����' - <br />-=�,� � .��� �� _. - <br />Phone � �i �� � . I�.,�� •�I' �3ir:•� .— <br />I T � 5 <br />Drivers License Number _. _ <br />� � �. <br />I here4r{ 1s for the following ]icense{s) for the term of one year, beginning Ju1y I, _ �"_, and ending June <br />3I, _:`�� , in the City of Rosevil�e, County of ��mS�Y� State of Minnesota. <br />License Required <br />Massage Therapy Establishment <br />The undersigned applicant malces this application pursuant t <br />the Council of the City of Roseville may from time to time <br />Signature <br />Date <br />FPe <br />$ 3 00.00 <br />$150.00 Bacicground Checic <br />(new license only) <br />✓Iinnesota and regulation as <br />a Statue �176.182. <br />_ .��_ -- --- <br />� <br />If completed license should be mailed somewhere other than the business address, please advise. <br />'.._..._.._....4 _ � � �,,,z� �.. �,.� _... <br />
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