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2005_0711_Packet
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2005_0711_Packet
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5/12/2014 1:23:22 PM
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9/14/2009 10:03:02 AM
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Roseville City Council
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Council Agenda/Packets
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���� � � <br />,`�`.�" ,� ,dl : � <br />City of Rosevil�e <br />Finance Depar�ment, License Division <br />2G60 Civic Cen�er Drive, RosevilIe, MN 55113 <br />(65l) 792-7034 <br />Massage Therapy Establishment License Appk�cation <br />Susiness Name � � '�- � � �..'�- � `� �i—[ �c.. u f"� � c�. i Z:r Y'1 <br />r-� �{ ,- <br />e <br />€3usiness Address `� � 4.-. `.7� �� �.., C� ��,.. r.r • '�,� ���d.3e_� ��-��c:_ E'�. G"�- <br />ry �.. J� � �s `� ti- .. �` �'' � ;� �..�, _�- � 4 : i <br />Busi��ess Phone �<,f �.- [ <br />Emaif Address t`" � E � �;.. is "�' 1.� �'4 �a �, z �5. �� � ��•-� <br />Person to Contcrct in Kegar•d to Bi�siness Liceizse: <br />�'�, �� �,�;� . <br />Legal Name _ �� � �- �"� <br />Address <br />�r'� �, c4. � - CY.. <br />0 <br />P11one �ate of Birth <br />Dri�ers Lice��se Nun-�ver � <br />__ r <br />�-_-•> <br />I hereby apply for the fallawing liceizse(s} for tlle tenn of one year, begin3ling 7uEy 1, �} C2 �' �, ai3d ending Juna <br />31, ` t7 ��,€n the City of Rosevi[le, Counfy of Ramsey, StaEe af Miiviesota. <br />License Required Fee <br />Massage `I'l�erapy �stablishme�at $304.00 <br />$150,00 Bacicgro�nd Ghecic <br />(new licei�se only) <br />The ualdersigi�ed appiicaut m�lces th�s application purstiai�t to all the laws of the Siatc of Minnesota a�id regt�latio�l as <br />d�e Coi3ncai c�f tlle City of Roseville �nay froi7� time to ti�i7e prescribe, incl 'fi�g 'miesota tahie #176.1_82. <br />y -; � <br />Signature .-�.�=�"� <br />,� �" � <br />Date C-' ` �� � - ` �.� . � �..a ,� �. <br />�1' completed license should be mailed somewhere other than thc business address, please advise. <br />
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