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CITY OF LITTLE CANADA <br />APPLICATION FOR MASSAGE THERAPY ESTABLISHMENT LICENSE <br />,7 Massage Therapy Principal Use — License Fee S300 <br />Massage Therapy Accessory Use — License Fee $100 <br />(Accessory or incidental use to properly zoned beauty salon or fitness center) <br />V New Application Renewal Application <br />Please complete the following application information. If the application is by a. natural person, form <br />should be completed by such person; if by a corporation, by an officer thereof; if by a partnership, by <br />one of the partners; if by an unincorporated association, by the manager or managing officer thereof, <br />Name of Applicant (name of individual partnership, corporation, or association): <br />(If Individual) LAST FIRST <br />FULL MIDDLE NAME <br />2. If accessory use, name of Beauty Salon or Fitness Center under which applicant will be doing <br />business, business address, and telephone number: <br />Business Name NA/ <br />Business Address <br />Business Telephone <br />3. Type of Applicant: <br />Individual < Partnership Corporation „Association <br />Other <br />4. A. If applicant is an Individual: <br />Name ycx. vim.. <br />LAST FIRST FULL MIDDLE NAME <br />Date of Birth <br />Residence Address,2770/ c . <.,.c'ia L �> c ye �a:,, d i-sc.•c; / /lam&20 J 7 <br />Business Address 2( 6 '/%2 ,'d (C Si: L 1- 1-fc -_ C w: <br />Business Telephone ' 2-52, o <br />Social Security Nunfbe; <br />Driver's License Numli <br />Residence Telephon <br />