90-176 WFiITE - CITV CIERK
PINK - FINANCE GITY OF SAINT PAITL Council �
. CANARY - DEPARTMENT
BLUE - MAVOR . FIIC NO• O� /��
�
Council Resolution �3,
Presented By
Referred To... Committee: Date
Out of Committee By Date
RESOLVED: Tha� Application (I.D. 4�16848) for a Ma.ssage Therapist License by
Mar� Berry DBA Sister Rosalind's Professional Massage Center at
1999 Ford Parkway be and the same is hereby approved.
�
i
I
I
I
8���&3N� CO�TNCIL MEMBERS Requested by Department of:
Y � Nays i
im nd Di�nd
on �swi�z � In Favor
G s it z �,ong � �
R tman �accab�� � _ Against BY
S eibel Rett�n
So �en i;���e ■
Adop e��y Co��n Date J„� 3 �' ���� Form Approved by C' Attorney
Certified Pas e n il retar By � �! �
By
Approved by vor: D r��t4� � � ���� Approved by Mayor for Submission to Council
B G��������� BY
Y
PIfBUSNEO F�? 1 � i 9 9 0
. . ' • ��-t'o� 7(0
DEPARTM[NT/QFFICE/WI�NGI °"TE'"'�"�° � GREEN SHEET NO. �O�O
Finance & .Mana ement License INITIAUDATE INITIAUDATE
CONTACT PERSON R PHONE �pEPAHTMENT DIRECTOR �qTY COUNqI
Kris Van Horn/298-50 6 �� �cmr�rra+Nev 0 CITY CI.ERK
MUST BE ON COUNCIL AQENDA BY(DA ) ROU71N0 �BUDOET DIRECTOR flN.8 MOT.SERVICES DIR.
�MAVOR(OR ASSISTANn � Council Research
TOTAL N OF SIONATURE PA 8 (CLIP ALL LOCATIONS FOR SIQiNATURE)
ACT10N REGUESTED:
Application for a ssage Therapist License (I.D. �C16848)
►� �i I�RD
RECOMMENDAT�ONB:Approw py or (i� COUNCIL COMMITTEE/�ARCH REPORT OPTIONAL
_PIANNINO COMMIBSION __ VIL SERVI�OOMMI8SION ANALY8T PHONE N0.
_CIB COMMITTEE _
_BTAFF CON
—asrpict couRr �
SUPPORT$WHICH COUNpL OBJECTIVE
INITIATINO PROBLEM.ISSUE.�PORTU (Who.Whet.WMn,Wh�`
Mary Berry requests Council ap'� Pherapist License at
1999 Ford Parkway� ( ister Ros � 11 required fees and
applications have b en submi' — iewed and approved
this application.
ADVANTA(iE8 IF APPROVED:
\
DISADVANTIlOES IF APPROVED:
RECEIUEp
J�iN2219.90
CITY CLERK
DISADVANTA(iE8 IF NOT APPROVED:
�ourtcil l�esearch Center
JAN � 21�9p
TOTAL AMOUNT OF TRANBACTION : I�ST/I�VENUE 011DOETED(qRCLE ON� YES NO
FUNDING SOURCE ACTIVITY NUM9ER
�Naran�iNFORau►�:�exwuN�
d
� r
� . � y
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE QREEN 8HEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASINi3 OFFICE(PHONE NO.29�-4225).
ROUTING ORDER:
Bslow are preferred routings for the five most frequent rypss of documents:
CONTRAC�S (aesumas authorfzed COUNqL RESOWTION (Amend, BdptsJ
budyet exists) Accept. arants)
1. Outside Agency 1. Department Director
2. Initiatfng Department 2. Bu�Jget Director
3. Cfty Attomey 3. Gty Attomey
4. Mayor 4. MayarM�stant
5. Flnance d�Mymt 3vca. Diractor 5. Gty Council
6. Fnance Accountlng 6. Chief ACCOUMaM, Fin�Mgmt 3vcs.
ADMINISTWITIVE ORDER (Budpst, OOUNCIL RESOLUTION (��DINANCE
f�evision
1. Acthdty Manaper 1. Inftiatf�DepertmeM Dirsctor
2. DspaRmeM�uMaM 2. City Attorney
3. Me /Assistant
a. s�a� a. ary councu
5. Gty Clerk
6. qdef AxouMant, Fln�Mgmt Sres.
ADMINI3TRATIVE ORDERS (all others)
1. Initiating Departmsnt
2. City Attorney
3. Mayar/AssistaM
4. City qerk .
TOTAI NUMBER OF SIONATURE PACaES
Indicate the�k of pag�on whbh signatures are required and pa e�rcOp
eech of these�
ACTION RE(�UESTED
D�c�ibe whet the proJscU►puset sseks W accompliah in either chro�ologi-
cal order or oMer of importance,whfchswr ia rtwst appropnate for the
i�us. Do not write complste aeMences. Begin each item in ycwr list with
a verb.
RECOMMENDATIONS
CaripleM if the issus in queatfon has bssn pr�ented before arry body, public .
a private.
SUPPORTS WHlqi OOUN(�L OBJECTIVE?
Indk:ets wh�h Council objsctive(s)!��prol����PP�bY���W
the key word(s)(HOUSIN(i, REdiEATION, NEIGHBORHOOD3, ECONOMIC DEVELOPMENT,
BUDCiET, SEWER SEPARATIOI�.(SEE COMPLETE LIST IN INSTRUCTIONAL NIANUAL.)
COUNCIL COMMITTEFJRE3EARCH REPORT-OPTIONAL AS RE�UESTED BY COUNCIL
INITIATIN(i PROBLEM,ISSIJE,OPPORTUNITY
Explafn the situation or oonditions that created a need for your proJect
or roquest.
ADVANTAC3E$IF APPROVED
Ind�ate whethsr this is simply an annual bud�et procedure requirod by law/ �
charter or whether then an spsciflc wa in wh�h ths Cky of Saint Paut
and its citizens will benetit from thia pro�t/action.
DISADVANTA(3ES IF APPROVED
What neyative efFecte or major chanyes to existing or past proceases might
this prqect/roquest produce if h fs passed(e.g.,treffic deiays, noise.
tax increases or asssssments)?To Whom?When?For how bng?
DI3ADVANTAQES IF NOT APPROVED
What will be ths nepative consequencss if ths promised action is not
approvsd?Inebility to dsNver service? Condnued high traffic, noise,
accidsnt rats4 t.oss of revenue?
FlNANCIAL IMPACT
Although you must tailor the infortnatbn you provide here to the issue you
are addressing, in gensral you muat answer iwo questlons: How much is it
pofny to coat?Who is 9a��PM
. � �90- ���
DIVISION OF LICENSE ANl) PERMIT ADMINISTRATION DATE �/o? ��S`I / � �j
INTERDF.PARTMF.NTAL REVIEW CHECKLIST A.ppn Processed/Rece ved by
Lic Enf Aud
Applicant Cl l:�. � Home Acldress y?j�3 1 ► \��rU �L•
' ` '„T '
Rusiness Ivame S� � � �c�Home Phone �9Cj� _ („� /5—
r. ��
Business Address L, t Type of License(s) `��`S��, �hQrc;`2c's-�
Business Phone ���-�j/a?�
Public Hearing D�te �C(�'� License I.D. 4f l (,p��
at 9:00 a.m. in �he Coun 1 Chambers,
3rd floor City H�11 and Courthouse State Tax I.D. �1 v�ZC�2�0 Q -�t 3�0
llate Notice Sent� Dealer �� ✓1 (/-�-
to Applicant
rederal Firearms 4� ✓1 'fl
Public Hearing '
�
DATE II�SPECTIUN
REVI�.W VERFIED (CQMPUTER) CUMMENTS
' A proveci Not A roved
�
Bldg I & D i pj� �
� o�.�j �
+ � ` ;(
Health Divn. i ' ��I�2U �'�;-� l.� � �c� .(�s-1:�°�`�
; , ��f� '
� _
Fire Dept. '� � ` !1
j � '\ I l�� �g.��'�t�Cy .
I `^'
I I, �
Yolice Dept. � I
�' I ►� �� �
License Divn. � �
I i
� �ao O�
City Attorney �� �\ �
�w � ��
I
li Date Received:
Site Plan ' 1 \ A
To Council Research
Lease or Letter j Date
f rom Landlord �'�� ���(
CURRENT INFORMATION NEW INFOIZMATION
Cur�ent Corporation Name: New Corporation Name:
Current DBA: New DBA:
Currer.t Officers: Insurance:
Bond:
Workers Compensation:
New Officers:
Stockholders:
- � - (r,��o_���
CITY OF ST. PAUL
DEPARTMENT OF FINANCE ANT MANAGF.MENT gERVICES
LICENSE AND PERMIT DIVISION
Please aasver a11 questions flilly and completely. This application is thoroughiy checked.
Any falsification �rill be cause Por denial.
Date - /Q 19� :
1. Application for � �7�� e. ��. .•� Ce,�/LS� (License)(Pe -
rmf t)
2. Name oP applicant�(�,�('l.� �, �jp�`�/�
3. If applicant is/ha,s been a married female, list maiden name � �$T-
�+. Date of birth 1j'`ti'�dd Age�Place of birth cNlQ.�j -�
5• Are you �. citizen of the United States Q� Native�Naturalized
6. Are you a registered voter_ uP� Where
�- c
7. Home Address �3� � � r,(,r'�('Q.,t,� �(. Ji Q.�,t�� Home Telephone b�0 ��l� _ _
8. Present business address ��j4°i �ZJI'�v '� "' ' ' G � '
-- �f Business Telephone�[��/��
9. Including your present business/employment, what business/employalent have you
followed for the past iive yeaxs. '
--,
Business/emplo�ent, Address .,
N�SS�an� l�iz ss� e l:P.ra� �3� ��A�'D �(/� ��; .
(�2 ��-uevU �i - . ,
10. Married�if ansxer is "yes", list name and a.ddress oP spouse
_�`,�I�s l� � ��.,► �i�. l�S�3 �u.r� �T �r- o�. �(/1,•�.
11. If this application is for a M assage Therapist License, list time so occupied.
� Years � Montns. !
12. Have you ever been axrested�If answer is "yes", list dates of arrests, where, !
charges convictions and sentences.
Date of axrest� 19 Where ,-;
,a iChaxge -
Conviction Sentence - �
Date of arrest 19 Where �-:
Charge ' I
!�J1
Conviction Sentence
� .
13. Give names a.*�d addresses of �wo persons, residents of St. Paul, Minnesota who ca.n
give inPormation concerning you.
N�'� ADDRESS (/� 9D�/7�/
a.� �u,v�r�s J'u.� �e 1.��-
� ��� 4 .� _ ����c � ,�c�.r� ST. -� �.
s /D� SS/�6
State oF Minnesota ) ��� I �� `��7 7
� Sj
County of Ra,msey )
��� �, �� (� � being first 3uly sworn, 3et�oses a.nd says upon oath
that ce ?�as read t'.:e foregoi._g�statement bearing his sigaati;re a.nd knows tr.e contents
thereof, and that �he same is true of his own �snor.riedge except as to those naz�ers
therein stated upor. informatior. and belief and as to those matters he believes then
to be true.
Subscribe3 ar.d sworn to bCf02'� �e �
ignat�,Lre oi Applicant
t. �s day f 19
� CLIFTON A. GUSTAFSM�,
^�1ot J o , � a:as y ouz�twr, n es ta 1�
� • � r � • `._ NOTARY PUBLIC—MINNESOTA
- - � � fi��P T t�NLY `�MY CommisswnMExpira�i uiTM18.1940.
r�iy Cc�miss_on expires l.1'B�RTY STAT �(��( x „
CLIFFS HARDWARE, tT�t�C.
�+CCI.kQ,fll•206-2