Laserfiche WebLink
CITY OF LITTLE CANADA <br />APPLICATION FOR MASSAGE THERAPY ESTABLISHMENT LICENSE <br />XMassage Therapy Principal Use — License Fee $300 <br />✓o Massage Therapy Accessory Use — License Fee $100 <br />(Accessory or incidental use to properly zoned beauty salon) <br />Now 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 />L <br />Of 'individual) I.,AST FIRST FULT., MIDDLE NAME <br />2. If accessory use, name of Beauty Salon under which applicant will be doing business, <br />business address, and telephone number: <br />Beauty Salon Name, �, ) (,_ I N-) r7 I i <br />Business Address )UloO_Rice 9Y''t_I.__4y,. : {je / / -`5 <br />Business Telephone L.061'' t 1 0 €€ 00(C52 . <br />3. Type of Applicant: <br />Individual Partnership / ` Corporation Association <br />Other <br />4. If applicant is an Individual: <br />Name <br />LAST FIRST FULL MIDDLE NAME <br />Date of Birth <br />Residence Address <br />Residence 'Telephone <br />Business Address <br />Business Telephone <br />Social Security Number <br />Driver's License Number <br />2 <br />