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Additional Aunlication Information <br /> Check one of the following and answer any additional questions: <br /> � New.Never Been Licensed Salon <br /> oChanae of Ownershin(Currentiv Licensed Salonl <br /> Previous Salon License Number <br /> Previous Salon Name <br /> Previous Salon Address <br /> Previous Salon Owner <br /> oSalon Relocation <br /> Previous Salon License Number <br /> Previous Salon Name <br /> Previous Salon Address <br /> OBusiness Structure Chan¢e <br /> Previous Salon License Number <br /> Salon Nam �� � Salon Leg�4�Vame <br /> S <br /> Salon Address <br /> ��..V �-' (A�� , <br /> City State Zip Code <br /> � �� � <br /> Salon Phon � er � � _ County of a on Locatio R <br /> Social Security Number or Fede ID(T r I�. /� Email Address <br /> y <br /> Salon Manager Last Name Salon Manager First Name Salon Manager MN License Ty,e of Manager License <br /> Number CosmetOlogist <br /> � ' / / O Manicurist <br /> �'t O Esthetician <br /> Please check the following days the salon is o en: <br /> O Monday Tuesday Wednesday �Thursday Friday Saturday O Sunday <br /> Is this saton open y appointment onl : Is this salon in a residence? <br /> O Yes� No If Yes,list one day per month salon is open: O Ye5 f�No <br /> l <br /> Number of Practitioners Working in Salon Total Square Feet of Salon, <br /> Required Cosmetology Salon Manicurist Salon Esthetician Salon <br /> Square Feet 1- 120 1- 100 1- 110 <br /> Per Practitioner Add 50 for each additional licensee Add 50 for each additional licensee Add 50 for each additional licensee <br /> 3 <br />