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-� � �� ��.... <br />���� � <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 />� � � . r <br />C�u a in�ss �'�r�� � � .�;a,'�-t� rf f ;��-� :�� ��–`—• <br />�T � �•--• -�� _ <br />Business Address ���_ _ ���.f��� � � � �`= � _ � <br />Busaness Phone �,�'�" ��• � � " ��.�•� � <br />� � <br />E��.ai� Address — <br />PeNSOn to Contact in RegaNd lo Busine.ss License: <br />Legal Name _ <br />:��dr�•ss <br />Phone <br />Drivers License Nucnber <br />— Date of Birth <br />Dee �?;� � ��-� <br />I hereby apply for the following iic�nse(s} for the tern of one year, begimlinga��r-1-; , and ending June <br />31, ��' �� �, in the City of Roseville, County of Rait�sey, State of Minnesota. <br />License Required Eee <br />Massage Therapy Establishment $300.00 <br />$150.00 Bacicground Checic <br />(new license oniy) <br />The undersigned 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 from time to time prescribe. including Minnesota Statue #176.k82_ <br />Signature _���,�_ '���y _ <br />[]; �r. /.� �� . �::�� <br />If completed license should he mailed somewhere other than the business address, please advise. <br />