Fillable APPLICATION FOR MASSAGE THERAPY PERMIT (City of Jordan, MN)

Fill Online, Printable, Fillable, Blank APPLICATION FOR MASSAGE THERAPY PERMIT (City of Jordan, MN) Form

Use Fill to complete blank online CITY OF JORDAN, MN (MN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

APPLICATION FOR MASSAGE THERAPY PERMIT (City of Jordan, MN)

On average this form takes 16 minutes to complete

The APPLICATION FOR MASSAGE THERAPY PERMIT (City of Jordan, MN) form is 3 pages long and contains:

  • 2 signatures
  • 10 check-boxes
  • 50 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Jordan, MN

BROWSE CITY OF JORDAN, MN (MN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
City of Jordan – Application for Massage Therapy Last Updated 8/25/2020 Page 1
APPLICATION FOR MASSAGE THERAPY PERMIT
CITY OF JORDAN
210 EAST FIRST STREET
JORDAN, MN 55352
952-492-2535
APPLICANT
NAME: ________________________________________________ WORK PHONE: ________________________
HOME PHONE: ____________________ ADDRESS: __________________________________________________
CITY: __________________________STATE: __________________________ZIP: __________________________
EMAIL_______________________________________________________________________________________
OWNER
NAME: _______________________________________________ DATE OF BIRTH: ________________________
HOME PHONE: _______________________________ WORK PHONE: ___________________________________
CURRENT ADDRESS: ___________________________________________________________________________
PREVIOUS ADDRESS (5
YEARS):_____________________________________________________________________________________
____________________________________________________________________________________________
CITY: _________________________STATE: ___________________________ZIP: _________________________
CURRENT EMPLOYERS: _________________________________________________________________________
EMPLOYER ADDRESS:
____________________________________________________________________________________________
PREVIOUS EMPLOYERS NAME, ADRRESS AND DATES (PAST 5 YEARS): ___________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
1. Type of entity:
Individual
Corporation
Partnership
Other: _______________
2. Legal description of land in which the proposed massage therapy business will be located along with a plan
of the area, showing the dimensions and location of the
area:_____________________________________________________________________________________
City of Jordan – Application for Massage Therapy Last Updated 8/25/2020 Page 2
_________________________________________________________________________________________
_________________________________________________________________________________________
3. Street Location of Property
(address):_________________________________________________________________
4. Present zoning of the above described property is: _______________________________________________
5. Floor number, street number and rooms in which the massage therapy will be conducted:
_________________________________________________________________________________________
_________________________________________________________________________________________
6. Proof that all real estate taxes have been paid for the property in which the business will be located. If not,
what years are unpaid and the amounts past
due.______________________________________________________________________
7. If new construction or remodeling is required, please attach building plans. Included_____ Yes ______ No
8. Name of the business in which the massage therapy will be conducted, if other than the name of the
applicant and submit a copy of the certificate as required by M.S 333.02 :
________________________________________________________________________________________
_________________________________________________________________________________________
9. Please attach a copy of your MN State License for Massage Therapy.
___________________________________________________________________________________________
_______________________________________________________________________________________
10. Personal Data (this is required as a part of the criminal history background check):
Height: ____________
Weight: ____________
Eye Color: __________
Hair Color: __________
11. Have you ever been convicted of a crime or violation of any ordinance? _____ Yes ______No
If yes, please note the time, place and offence for which the conviction occurred:
_________________________________________________________________________________________
____________________________________________________________________________________
12. Are you a U.S. Citizen or Resident Alien or have legal authority to work in the United States: ____ Yes
_____ No
13. Please include any and all previous names or alias used with when and where used:
_______________________________________________________________________________________________
_________________________________________________________________________________________
14. Do you meet the definition of massage therapist in the Jordan City Code 118.03:
____________________________________________________________________________________________
City of Jordan – Application for Massage Therapy Last Updated 8/25/2020 Page 3
I certify the above and attached information is correct.
Applicant Signature: _______________________________________ Date: ________________________
Owner Signature: __________________________________________ Date: _______________________
PROPOSED MEETING DATES: City Council__________________________
FOR OFFICE USE ONLY
DATE SUBMITTED: _________ DATE COMPLETE: ___________ IF INCOMPLETE, DATE LETTER SENT TO APPLICANT: _______
AMOUNT OF BACKGROUND FEE PAID: __________ DATE BACKGROUND FEE PAID: ___________
AMOUNT OF FEE PAID: _________ DATE FEE PAID: ___________ FILE #_________
CITY COUNCIL ACTION: _____ APPROVED _____ DENIED
DATE OF ACTION: _________________
DATE APPLICANT/PROPERTY OWNER NOTIFIED OF CITY COUNCIL ACTION: _________________
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

APPLICATION FOR MASSAGE THERAPY PERMIT (City of Jordan, MN)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 9 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document