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' � � <br />��� <br />City of Rasev�Ile <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55ll3 <br />(651)792-7034 <br />Massage Therapy Establishment License Application <br />Business Name „��_�i ,_ I 1�,},_�, <br />• {t y 1 ,/] j -•--- �— •---- -• - <br />/� �% f �+JNar�' ica/IL2T �� <br />Business Address ��� �����_ ��J1r.,J �- 11� • � � � <br />Business Phone ��a'��7 . ���� <br />�,z�r�axl Address __ ���'�_ _. ���_}__��� r-�� <br />Person to Contact in Regard to Business License: <br />Lz��i'� �'irnz ���f�C�-�t+--w �.� �� �-H'�� <br />}�dress -- _ . _.. — <br />r��— <br />L}_l��ti .�� —u� . r= _ `• " — — <br />Drivers License Number <br />I hereby apply for the following lxcei�se(s) for the ter�� of one year, b�gii��ii�g July ':�g �� , and ending June <br />31, �, in the City of Rasevitle, Couttry of Ramsey, State of Minnesota. <br />License Required Fee <br />Massage Therapy Establishment $300.00 <br />$150.00 Background Check <br />(new license only) <br />The undetsi�ed applicant makes this application pursuant to all the laws of the State of Minnesota and regulation as <br />the Council of the City of Roseville may ;•: ,i7 time to ti��e F�et•�� l,c_ ;:7�:�•.:i- �[inn�sata Statue �176. I$2. <br />Signature _ _ <br />Date � �� _ �• � <br />If completed license should be mailed somewhere other than the business address, please advise. <br />