Section 1 of 4 in this document
Shoreview

Massage Establishment License Application

Thank you for submitting your application. There are three ways to pay for your license:

  1. Online with a credit card - $103.40
  2. Call 651-490-4600 to pay with a credit card - $100
  3. Send a check to city hall - $100

Applicant information

Home address

Section 2 of 4 in this document

Business information

Address

Is this a home occupation business?

Please upload your certificate of insurance.

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NOTE: Even if you do not have any employees or only employ W-2/Independent contractors, you still need to fill out the MN Worker's Compensation form. The form can be download here. Fill out form and select appropriate response in box 1 or 2.

Please upload your certificate of compliance for Minnesota workers’ compensation law.

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Section 3 of 4 in this document

Consent for the release of information

This consent is for the relase of information in accordance with MSA 13.05, subd. 4(d)

I authorize the Ramsey County Sheriff’s Office to release criminal history data, as defined by Minnesota Statute 13.87, subd. 1 and driver’s license and traffic record data to the Deputy Clerk for the City of Shoreview. I understand that some of this data may be classified as private data under Minnesota statutes and I hereby give my informed consent to the release of that private data by the Ramsey County Sheriff’s Office to the deputy cerk for the City of Shoreview. This consent for the release of data is for the purpose of obtaining a permit or license with the City of Shoreview. This information cannot be used for any other purposes. This authorization may be revoked in writing by me at any time and in no event will it be valid for more than one year from the date below.

Full Legal Name

Home address

Date of birth

By signing this application, I:

  • Swear that all statements by me on this form are true and complete to the best of my knowledge
  • Am at least 18 years old
  • Have received a copy of Section 711 of the Shoreview City Code
  • Understand the conditions set forth for massage establishment licensees
  • Understand that false statements or omissions shall be sufficient cause for rejecting my license
  • Authorize the City of Shoreview to use this information to determine my suitability for obtaining a license.

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