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Attachment A <br />� �f <br />�� � �� � <br />Ci�y o� Roseville <br />F`�nance Depar�meni, Lp�ense I��vision <br />2660 Civic C'en�er Driv�, ltoseville, �VIIV �5113 <br />(651) 792-7036 <br />assa�� Z'hera�y Esi�b���hmen� L�cen�� App�ica��on <br />i`"L'�r+�� z'�� - f�" ��.�-�- t�-��'�lL L�'-1-�-7 G�� i_LC- n � —;� <br />i <br />B�siness Name � l�"�G �t�P r7s'.J ��r'-�{'.� i�"�,.�, r�..a.� i���/i ��•��� t-���;�:r..�. �/�.��/�i'tr' �:i <br />Business Address <br />Business Phone <br />Ert�ai! Address <br />��-C= / <br />'-.%.�� ��`� ��} � �Tr'li <br />u <br />Person to Cantact in Regard to Business License: <br />�ega! Name <br />Address <br />Phone <br />Dri�ers License Number <br />( �` t=r� �'. <br />��. ��G`S-r"' E/ r� lC � `� . <br />i��-� <br />Date of Birth <br />� <br />/ <br />�_ <br />-- --�- , . r_ <br />I E�ereby appiy for the fo�lowing license(s) for the term of ane year, beginning 7aly 1, , and endi�g <br />June 31, , in the City af Roseville, County of Ramsey, and State of Minnesata. <br />� i��sa� <br />Massage Therapy Establishment <br />� <br />$300.00 <br />$ i SO.QO Background Check <br />(new license only) <br />The undersigned applicant makes EFtis application purs�ant to all the laws of the State of Minnesota and regulation <br />as the Council of the City of Roseville rnay frorn 4rrke to iime prescribe, including Minnesota Statue #175.182. � <br />addition the a lieani acknqwled es that the are res ansible for reviewin the back ound and work �►isto of <br />their employees, including Ehose ihat have received a massag_e_[hera ist license from Et�e City_. <br />�,,��. ' / <br />Signat�re ,�� ' � - ,� � l�- �u- ��-- - ------ <br />Date —,�G� ��� <br />If ea�pieted �ceFese should be t�ailed somewhea•e otf�er than the business add�, �lease advise. <br />