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98-743ORfG1NA�. RESOLUTION Presented By� Referxed To RESOLVED: CITY OF SAINT PAUL, MINNESOTA 3 �{ Committee: Date 1 That application (iD #19980000471) 4or a Auto Repair Garage License(s) 2 by M& M AUTO REPAfR DBA M& M AUTO REPAIR at 1202 DALE ST N 3 be and the same is hereby approved with the following conditions: q 1. Vehicle parts, tires, oil or similar items may not be stored 5 outdoors. 6 2. No repair of vehicles may occur on the exterior of the lot � or in the public right-of-way. Yeas Bos Col Har Lan Rei AdoF AdoF By: Appx sy: Nays Absent I Requested by Department of: Office of License, Inspections and Environmental Protection By: v" '_"" � ��� .�— Form Approved by City Attorney B �1 �J � .-�_ Approved by Mayor for Submission to Council `'-.� Council File # � � � � Ordinance # Green Sheet � LP60065 DEPARTMENT/OFFICFICOUNCIL DATE INITIATED LIEPticensing GREEN SHEET No. LP 60065 �� �� � 3 ONTACT PERSON�& PHONE InitixVDate InibaVDate LOOM JAMES (JIM) (612) 26Cr9073 1� City Attomey UST BE ON COUNCIL AC�ENDA BY (DATE) ASSIGN ' e��v�sss jp/.1��lL� Q!^1i1� r+��6�� � CoundiResearch ROUTOIG CG!lfh�( t�i2e��::: � "� ORDER ;{UL 2 4 ��?8 TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR� ACTION REQUESTED: Coun61 approval of the following license appliqtion: License # � 998000047�, for M& M AUTO REPAIR, Doing Business As M& M AUTO REPAIR, at 1202 DALE ST N, ioduding the foVlowing business type(s): Auto Repair Ga2ge. RECOMMENDATIONS: ApprOVe(A) RejeCt(R) ERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: t. Has ihis person/firtn ever worked untler a contract for this tlepartment? PLANNING COMMISSION YES NO CIB COMMIITEE 2. Has this person/hrm ever been a city employee� � CIVIL SVC CINN, YES NO 3. Does this perso�rtn possess a skill not nortnally possessed by any curtent city employee? YES NO . Is fhis perso�rtn a fargeted vendoR - YES NO Explain ali yes answers on separete sheet and attach to green sheet INITIATING PROBLEM, 1SSUE, OPPORTUN�TY (Who, What, When, Where, Why): Requesting Gouncil approval for M& M Auto Repair DBA M 8 M Auto Repair for an Auto Repair Garage License at 1202 Dale St. N. ADVANTAGES IF APPROVED: � DiSADVANTqGES IF APPROVED: 61SADVFWTAGES IF NOT APPROVE6: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCF qCTiVITY NUMBER . FlNANCfAI iNFORMATiON: - (EXPLAIN) - . ' °qi� -'1'�1�3 CLASS 11I LICENSE APPLICATION THIS APPLICATIO'.v IS SUB7ECT TO RFVIEW BY TI-� PL�LTC CITY OF S aNT PAUL o-,« asL;.�, L,� ;:o:s zna &�.:roame�ut 7rolcnion 350 Si?_� Sc S�+�e3� Si—.t?e�! Viroz SSl�3 (E'.'.) �at9:9� :fx (cl.):e59II< PLEASE TYPE OR PRII��TT' IN P,v?C � T}pe of Lice :se(s) being applied for. l a 1 a y� r'�b �(�� t r� l� �-�« ] S o� I�a O Compznj� \z-ne: COipotalion If business is incorpo: ated, give date of Do;ng Business As: Business Address: e svu� %'� _ Business Phone: �.� 1 0 b`O � Between what cross streeu is the business lo::ated? ./�`�G�'V✓�fc c.�.c� ��h Are the p:emis�s now o:: upied?�'��� What T}pe of Busiaess? �'w ���-�e�C-�ti,f (.. � Mail To Address: �� � �l i�LG�,F"t'C ��� � j�^�.�_ _ sm� aaam. - �;w Applicant Infom I�Tame and I'itle: � F'vse r , nfiame Home Address: `� U J' �-�-x�- Q/`eh��`K/ �j (/ l�j �-G r Stree[ Addes�e � ,f C�� / Aate of Buth: / I- a GI S 3 Place of Birth: `� �Cl�Z� �- /�.( r ??ave yon ��� beea concric?ed of any felony, crime or ��olation of any city ordinance other than ffaffic. Date of azrest: Charge: _ Convicrion; Whae? Seutence: S1acc Zip ofthestreet? N�CG�'2s i � �1�� L'est e, , r �Title v�--7�J c Zti (S� Smic Zip HomePhone: � �3% 3GL�.3. � YES NO X List the names and resideaces of three persons of good moral character, living within the Twin Cities Metro Are.� not related to the applicant or 5nancially intereste3 in the premises or business, u�ho may be referted to as to the applicanPs character: List licenses which you Have atry of the above named �.' ADDRESS � U/iUIL�� �Ga(,rjl.�.ith��r-u Gf1.A ///,� � 1�.(/! l», i �,�h,� a»� .�� � foimerly held, or may have an interest �v����.�u� �C�.� e� ever b revoked7 YES PHQNE NO If yes, list the dates and reasoas for revocation: vis�� Are you going to operate this business personally? _� YES 1�T0 If not, �� �3 operate it1 Q y��1�� \0 � F"ust�z�ae Hoac Address: Stroct \aye VfidZSeSnilixi (�.eidn) City I,rst State Dstc ofBvlL Zip Pione \*umSer Areprn3 g�s.e :e h�� e a-W�;z�e; or vsi��:t in L;s b:_�_ ess? YES ' if ;I:e r±&�ager is not t'�e s_. zs ;ne operztoi, p;ezse cou ple,� the ioile�aing info,=.,a:ioa: First`�me :.5dd{eLtitizi (�Qzid:n) ?ast DztcofBixth t-iome Addass: St�-t \zye Ciry Siste Zip Phoac \�bct List all other o�ce-. s of the coiporation: Of'f'ICER TITLE HO?v� HO?�fE BL'SL'vESS ?�TAT�/Ei (Qmce Held) ADD?2ESS PHONE PHOI�TE �"�i/l�'L�-Zi If business is a parmership, please include the following in{o�ation for each par�er (use additional pages if necessarg): � / i . / • _ /J/IO ��fi-r„ . (-Maidrn) HomeAddrw: Stm[]vame City I,ast State DA�EOF BII2TH f'�' , Da4 0: F'usttiame ?.SiddleInitid (�✓aidrn) I.ast DatcofBirth Home Addreas: Streec?��e Ciry State Zip PFione I�'umber MIDINESOTA TAX IDENTIFICATION N[IMBER - Pursuant to tim Law•s of Minnesota, 1984, Chapter 502, A:ticle 8, Section 2(270.72) (T'ax Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax identification number and the social secutity number of each license applicaat Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we aze tequired to ad�nse you of the followang regarding the ese of the Minnesota TaY Ideatification Niffiber: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's wzthholding or moior ve7vcle excise tvtes; - Upon receiving tLis information, the lieensing authority wiU supply it only to the Minnesota Department of Revenue. However, under the Federai Exchange of Information Agreement, the Department of Revenue may supply ttns information to the Iatemal Revenue Seivice. Mwnesota Tax Id�tificarion Niffibas (Sales & Use T�c Number) may be obtained from the State of M'innesota, Business Records Department, 10 River Park Plaza (612-296-6181). . Social Security IvTUmber. �G K"` 1 �(' � 1� Minnesota Tax IdentiScaUOn Number: � L"'fe� � O� _ If a Minnesota Tax IdentiScauon Number is not requ'ved for the business being operated, indicate so by placing an "X" in the box �:. �r ` 2/7 8/97 Please lis! }•os emp]o}ment history for tt�e pre�:ois fi�e (�);�ear pr.iod: `t8 -'ty3 CERTIFICATION OF WORiCERS' CO?�iPENSATIODi COVERAGE PURSUANT TO'J�?QESOTA STATU'IE 176.582 I haeb}' certifi� �hat I, or m� comp2�y, ain in compliznce �3ith the ��nrl:�s' compensalion vsurznce coverage requirements of Mianesota S a7:te l i6.182, subdi�;son 2. I zLso ti*�dr, s�d thzt p*o�isim of fise izafo, in this certificalion constitutes suuticient grow�ds for ad� erse xclion z¢air.st all licet:ses held, includir.g reti�ocztion and suspr.:s:oa of szid licznses. \TZme of U�serznce Compzny: PolcyNumber: Co erag, I hz� e no e;*ipio�'ezs co�•erzd under �ror!:ers compeasztion ssuzn (I?�ZTI�'aL.S) A1�Y FAISIFICATION OF �\SWERS GIVEN OR 1S.ATERiAL SIIB141TTTED �II,L REStiLT LY DE\TAL OF TFIIS APPLICATION I hereby state that I�a��e znsu ered a11 of Lhe preceding quzstions, and that the i. f'ormatioa contained hr, ein is true and cor, ect to the best of my ]rnou9edge and belief. I hereby state further fhat I ha��z recei��ed no mone}• or other co;isideration, by wzy of loan, gift, coasibution, or otheiuise, othe; than aheady disclose3 in the applicztioa aiuch I herev�ith sub:nitted I also understand tlus premise may be inspected 6y� police, fue, hezt �u z�d o��er ci;�� officizls 2t xny z�d zil tir.±es u�hen Lhe bi:�i*3zss is in o�e:2tie�. -C�� Date We Aill accept pz��ment b�• cash, check (made pzy�a6le to Cit� of Saint P�vij or credit card (1'UC er \'isa). IFPAYINGBYCREDITCARDPL£ASECOMPLPTETHEFOZLON'INGINFORMATION: � MasterCazd � Visa EXPIItAI'IOI�T DATE: � � � � ACCOUNf NUMBER: � � � � � � � � � � � � � � � � Date *'Note: If flus appiication is Food/Liquor related, please contact a Ciry of Saini Paul Health Inspector, Steve Olson (266-9139), to reenew plans. If any subs[antial cbanges to structure aze ancicipate,� please contact a Ciry of Saint Psul Plan Examiner at 266-9007 ta apply for building peimits. Ifthere are any changes to the parking lot, floor space, or for new operations, please contact a City of Saint Pau1 ZAning Inspector at 266-9008. Ali appGcations mquim the following documents. Please attach these documents when submitting your application: 1. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The following data should be on she site plan (preferably on an 81l2" x 11" or 8112" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1"= 20'. ^N shouid be indicated toward the top. - Piacement of all pertinent features of the interior of the licensed facility such as seating azeas, Idtchens, offices, repair area, parking, rest rooms, etc. - -If a request is for an addition or expansion of the licensed facility, indicate both the cwrent area and the proposed expansion 2. A copy of your lease agreement or proof of ownership of the propertp. SPECIFIC LICENSE APPLICATIONS REQUIItE ApDTTIONAL I,1'FORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> ; £3� v�s,9� ORfG1NA�. RESOLUTION Presented By� Referxed To RESOLVED: CITY OF SAINT PAUL, MINNESOTA 3 �{ Committee: Date 1 That application (iD #19980000471) 4or a Auto Repair Garage License(s) 2 by M& M AUTO REPAfR DBA M& M AUTO REPAIR at 1202 DALE ST N 3 be and the same is hereby approved with the following conditions: q 1. Vehicle parts, tires, oil or similar items may not be stored 5 outdoors. 6 2. No repair of vehicles may occur on the exterior of the lot � or in the public right-of-way. Yeas Bos Col Har Lan Rei AdoF AdoF By: Appx sy: Nays Absent I Requested by Department of: Office of License, Inspections and Environmental Protection By: v" '_"" � ��� .�— Form Approved by City Attorney B �1 �J � .-�_ Approved by Mayor for Submission to Council `'-.� Council File # � � � � Ordinance # Green Sheet � LP60065 DEPARTMENT/OFFICFICOUNCIL DATE INITIATED LIEPticensing GREEN SHEET No. LP 60065 �� �� � 3 ONTACT PERSON�& PHONE InitixVDate InibaVDate LOOM JAMES (JIM) (612) 26Cr9073 1� City Attomey UST BE ON COUNCIL AC�ENDA BY (DATE) ASSIGN ' e��v�sss jp/.1��lL� Q!^1i1� r+��6�� � CoundiResearch ROUTOIG CG!lfh�( t�i2e��::: � "� ORDER ;{UL 2 4 ��?8 TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR� ACTION REQUESTED: Coun61 approval of the following license appliqtion: License # � 998000047�, for M& M AUTO REPAIR, Doing Business As M& M AUTO REPAIR, at 1202 DALE ST N, ioduding the foVlowing business type(s): Auto Repair Ga2ge. RECOMMENDATIONS: ApprOVe(A) RejeCt(R) ERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: t. Has ihis person/firtn ever worked untler a contract for this tlepartment? PLANNING COMMISSION YES NO CIB COMMIITEE 2. Has this person/hrm ever been a city employee� � CIVIL SVC CINN, YES NO 3. Does this perso�rtn possess a skill not nortnally possessed by any curtent city employee? YES NO . Is fhis perso�rtn a fargeted vendoR - YES NO Explain ali yes answers on separete sheet and attach to green sheet INITIATING PROBLEM, 1SSUE, OPPORTUN�TY (Who, What, When, Where, Why): Requesting Gouncil approval for M& M Auto Repair DBA M 8 M Auto Repair for an Auto Repair Garage License at 1202 Dale St. N. ADVANTAGES IF APPROVED: � DiSADVANTqGES IF APPROVED: 61SADVFWTAGES IF NOT APPROVE6: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCF qCTiVITY NUMBER . FlNANCfAI iNFORMATiON: - (EXPLAIN) - . ' °qi� -'1'�1�3 CLASS 11I LICENSE APPLICATION THIS APPLICATIO'.v IS SUB7ECT TO RFVIEW BY TI-� PL�LTC CITY OF S aNT PAUL o-,« asL;.�, L,� ;:o:s zna &�.:roame�ut 7rolcnion 350 Si?_� Sc S�+�e3� Si—.t?e�! Viroz SSl�3 (E'.'.) �at9:9� :fx (cl.):e59II< PLEASE TYPE OR PRII��TT' IN P,v?C � T}pe of Lice :se(s) being applied for. l a 1 a y� r'�b �(�� t r� l� �-�« ] S o� I�a O Compznj� \z-ne: COipotalion If business is incorpo: ated, give date of Do;ng Business As: Business Address: e svu� %'� _ Business Phone: �.� 1 0 b`O � Between what cross streeu is the business lo::ated? ./�`�G�'V✓�fc c.�.c� ��h Are the p:emis�s now o:: upied?�'��� What T}pe of Busiaess? �'w ���-�e�C-�ti,f (.. � Mail To Address: �� � �l i�LG�,F"t'C ��� � j�^�.�_ _ sm� aaam. - �;w Applicant Infom I�Tame and I'itle: � F'vse r , nfiame Home Address: `� U J' �-�-x�- Q/`eh��`K/ �j (/ l�j �-G r Stree[ Addes�e � ,f C�� / Aate of Buth: / I- a GI S 3 Place of Birth: `� �Cl�Z� �- /�.( r ??ave yon ��� beea concric?ed of any felony, crime or ��olation of any city ordinance other than ffaffic. Date of azrest: Charge: _ Convicrion; Whae? Seutence: S1acc Zip ofthestreet? N�CG�'2s i � �1�� L'est e, , r �Title v�--7�J c Zti (S� Smic Zip HomePhone: � �3% 3GL�.3. � YES NO X List the names and resideaces of three persons of good moral character, living within the Twin Cities Metro Are.� not related to the applicant or 5nancially intereste3 in the premises or business, u�ho may be referted to as to the applicanPs character: List licenses which you Have atry of the above named �.' ADDRESS � U/iUIL�� �Ga(,rjl.�.ith��r-u Gf1.A ///,� � 1�.(/! l», i �,�h,� a»� .�� � foimerly held, or may have an interest �v����.�u� �C�.� e� ever b revoked7 YES PHQNE NO If yes, list the dates and reasoas for revocation: vis�� Are you going to operate this business personally? _� YES 1�T0 If not, �� �3 operate it1 Q y��1�� \0 � F"ust�z�ae Hoac Address: Stroct \aye VfidZSeSnilixi (�.eidn) City I,rst State Dstc ofBvlL Zip Pione \*umSer Areprn3 g�s.e :e h�� e a-W�;z�e; or vsi��:t in L;s b:_�_ ess? YES ' if ;I:e r±&�ager is not t'�e s_. zs ;ne operztoi, p;ezse cou ple,� the ioile�aing info,=.,a:ioa: First`�me :.5dd{eLtitizi (�Qzid:n) ?ast DztcofBixth t-iome Addass: St�-t \zye Ciry Siste Zip Phoac \�bct List all other o�ce-. s of the coiporation: Of'f'ICER TITLE HO?v� HO?�fE BL'SL'vESS ?�TAT�/Ei (Qmce Held) ADD?2ESS PHONE PHOI�TE �"�i/l�'L�-Zi If business is a parmership, please include the following in{o�ation for each par�er (use additional pages if necessarg): � / i . / • _ /J/IO ��fi-r„ . (-Maidrn) HomeAddrw: Stm[]vame City I,ast State DA�EOF BII2TH f'�' , Da4 0: F'usttiame ?.SiddleInitid (�✓aidrn) I.ast DatcofBirth Home Addreas: Streec?��e Ciry State Zip PFione I�'umber MIDINESOTA TAX IDENTIFICATION N[IMBER - Pursuant to tim Law•s of Minnesota, 1984, Chapter 502, A:ticle 8, Section 2(270.72) (T'ax Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax identification number and the social secutity number of each license applicaat Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we aze tequired to ad�nse you of the followang regarding the ese of the Minnesota TaY Ideatification Niffiber: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's wzthholding or moior ve7vcle excise tvtes; - Upon receiving tLis information, the lieensing authority wiU supply it only to the Minnesota Department of Revenue. However, under the Federai Exchange of Information Agreement, the Department of Revenue may supply ttns information to the Iatemal Revenue Seivice. Mwnesota Tax Id�tificarion Niffibas (Sales & Use T�c Number) may be obtained from the State of M'innesota, Business Records Department, 10 River Park Plaza (612-296-6181). . Social Security IvTUmber. �G K"` 1 �(' � 1� Minnesota Tax IdentiScaUOn Number: � L"'fe� � O� _ If a Minnesota Tax IdentiScauon Number is not requ'ved for the business being operated, indicate so by placing an "X" in the box �:. �r ` 2/7 8/97 Please lis! }•os emp]o}ment history for tt�e pre�:ois fi�e (�);�ear pr.iod: `t8 -'ty3 CERTIFICATION OF WORiCERS' CO?�iPENSATIODi COVERAGE PURSUANT TO'J�?QESOTA STATU'IE 176.582 I haeb}' certifi� �hat I, or m� comp2�y, ain in compliznce �3ith the ��nrl:�s' compensalion vsurznce coverage requirements of Mianesota S a7:te l i6.182, subdi�;son 2. I zLso ti*�dr, s�d thzt p*o�isim of fise izafo, in this certificalion constitutes suuticient grow�ds for ad� erse xclion z¢air.st all licet:ses held, includir.g reti�ocztion and suspr.:s:oa of szid licznses. \TZme of U�serznce Compzny: PolcyNumber: Co erag, I hz� e no e;*ipio�'ezs co�•erzd under �ror!:ers compeasztion ssuzn (I?�ZTI�'aL.S) A1�Y FAISIFICATION OF �\SWERS GIVEN OR 1S.ATERiAL SIIB141TTTED �II,L REStiLT LY DE\TAL OF TFIIS APPLICATION I hereby state that I�a��e znsu ered a11 of Lhe preceding quzstions, and that the i. f'ormatioa contained hr, ein is true and cor, ect to the best of my ]rnou9edge and belief. I hereby state further fhat I ha��z recei��ed no mone}• or other co;isideration, by wzy of loan, gift, coasibution, or otheiuise, othe; than aheady disclose3 in the applicztioa aiuch I herev�ith sub:nitted I also understand tlus premise may be inspected 6y� police, fue, hezt �u z�d o��er ci;�� officizls 2t xny z�d zil tir.±es u�hen Lhe bi:�i*3zss is in o�e:2tie�. -C�� Date We Aill accept pz��ment b�• cash, check (made pzy�a6le to Cit� of Saint P�vij or credit card (1'UC er \'isa). IFPAYINGBYCREDITCARDPL£ASECOMPLPTETHEFOZLON'INGINFORMATION: � MasterCazd � Visa EXPIItAI'IOI�T DATE: � � � � ACCOUNf NUMBER: � � � � � � � � � � � � � � � � Date *'Note: If flus appiication is Food/Liquor related, please contact a Ciry of Saini Paul Health Inspector, Steve Olson (266-9139), to reenew plans. If any subs[antial cbanges to structure aze ancicipate,� please contact a Ciry of Saint Psul Plan Examiner at 266-9007 ta apply for building peimits. Ifthere are any changes to the parking lot, floor space, or for new operations, please contact a City of Saint Pau1 ZAning Inspector at 266-9008. Ali appGcations mquim the following documents. Please attach these documents when submitting your application: 1. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The following data should be on she site plan (preferably on an 81l2" x 11" or 8112" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1"= 20'. ^N shouid be indicated toward the top. - Piacement of all pertinent features of the interior of the licensed facility such as seating azeas, Idtchens, offices, repair area, parking, rest rooms, etc. - -If a request is for an addition or expansion of the licensed facility, indicate both the cwrent area and the proposed expansion 2. A copy of your lease agreement or proof of ownership of the propertp. SPECIFIC LICENSE APPLICATIONS REQUIItE ApDTTIONAL I,1'FORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> ; £3� v�s,9� ORfG1NA�. RESOLUTION Presented By� Referxed To RESOLVED: CITY OF SAINT PAUL, MINNESOTA 3 �{ Committee: Date 1 That application (iD #19980000471) 4or a Auto Repair Garage License(s) 2 by M& M AUTO REPAfR DBA M& M AUTO REPAIR at 1202 DALE ST N 3 be and the same is hereby approved with the following conditions: q 1. Vehicle parts, tires, oil or similar items may not be stored 5 outdoors. 6 2. No repair of vehicles may occur on the exterior of the lot � or in the public right-of-way. Yeas Bos Col Har Lan Rei AdoF AdoF By: Appx sy: Nays Absent I Requested by Department of: Office of License, Inspections and Environmental Protection By: v" '_"" � ��� .�— Form Approved by City Attorney B �1 �J � .-�_ Approved by Mayor for Submission to Council `'-.� Council File # � � � � Ordinance # Green Sheet � LP60065 DEPARTMENT/OFFICFICOUNCIL DATE INITIATED LIEPticensing GREEN SHEET No. LP 60065 �� �� � 3 ONTACT PERSON�& PHONE InitixVDate InibaVDate LOOM JAMES (JIM) (612) 26Cr9073 1� City Attomey UST BE ON COUNCIL AC�ENDA BY (DATE) ASSIGN ' e��v�sss jp/.1��lL� Q!^1i1� r+��6�� � CoundiResearch ROUTOIG CG!lfh�( t�i2e��::: � "� ORDER ;{UL 2 4 ��?8 TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR� ACTION REQUESTED: Coun61 approval of the following license appliqtion: License # � 998000047�, for M& M AUTO REPAIR, Doing Business As M& M AUTO REPAIR, at 1202 DALE ST N, ioduding the foVlowing business type(s): Auto Repair Ga2ge. RECOMMENDATIONS: ApprOVe(A) RejeCt(R) ERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: t. Has ihis person/firtn ever worked untler a contract for this tlepartment? PLANNING COMMISSION YES NO CIB COMMIITEE 2. Has this person/hrm ever been a city employee� � CIVIL SVC CINN, YES NO 3. Does this perso�rtn possess a skill not nortnally possessed by any curtent city employee? YES NO . Is fhis perso�rtn a fargeted vendoR - YES NO Explain ali yes answers on separete sheet and attach to green sheet INITIATING PROBLEM, 1SSUE, OPPORTUN�TY (Who, What, When, Where, Why): Requesting Gouncil approval for M& M Auto Repair DBA M 8 M Auto Repair for an Auto Repair Garage License at 1202 Dale St. N. ADVANTAGES IF APPROVED: � DiSADVANTqGES IF APPROVED: 61SADVFWTAGES IF NOT APPROVE6: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCF qCTiVITY NUMBER . FlNANCfAI iNFORMATiON: - (EXPLAIN) - . ' °qi� -'1'�1�3 CLASS 11I LICENSE APPLICATION THIS APPLICATIO'.v IS SUB7ECT TO RFVIEW BY TI-� PL�LTC CITY OF S aNT PAUL o-,« asL;.�, L,� ;:o:s zna &�.:roame�ut 7rolcnion 350 Si?_� Sc S�+�e3� Si—.t?e�! Viroz SSl�3 (E'.'.) �at9:9� :fx (cl.):e59II< PLEASE TYPE OR PRII��TT' IN P,v?C � T}pe of Lice :se(s) being applied for. l a 1 a y� r'�b �(�� t r� l� �-�« ] S o� I�a O Compznj� \z-ne: COipotalion If business is incorpo: ated, give date of Do;ng Business As: Business Address: e svu� %'� _ Business Phone: �.� 1 0 b`O � Between what cross streeu is the business lo::ated? ./�`�G�'V✓�fc c.�.c� ��h Are the p:emis�s now o:: upied?�'��� What T}pe of Busiaess? �'w ���-�e�C-�ti,f (.. � Mail To Address: �� � �l i�LG�,F"t'C ��� � j�^�.�_ _ sm� aaam. - �;w Applicant Infom I�Tame and I'itle: � F'vse r , nfiame Home Address: `� U J' �-�-x�- Q/`eh��`K/ �j (/ l�j �-G r Stree[ Addes�e � ,f C�� / Aate of Buth: / I- a GI S 3 Place of Birth: `� �Cl�Z� �- /�.( r ??ave yon ��� beea concric?ed of any felony, crime or ��olation of any city ordinance other than ffaffic. Date of azrest: Charge: _ Convicrion; Whae? Seutence: S1acc Zip ofthestreet? N�CG�'2s i � �1�� L'est e, , r �Title v�--7�J c Zti (S� Smic Zip HomePhone: � �3% 3GL�.3. � YES NO X List the names and resideaces of three persons of good moral character, living within the Twin Cities Metro Are.� not related to the applicant or 5nancially intereste3 in the premises or business, u�ho may be referted to as to the applicanPs character: List licenses which you Have atry of the above named �.' ADDRESS � U/iUIL�� �Ga(,rjl.�.ith��r-u Gf1.A ///,� � 1�.(/! l», i �,�h,� a»� .�� � foimerly held, or may have an interest �v����.�u� �C�.� e� ever b revoked7 YES PHQNE NO If yes, list the dates and reasoas for revocation: vis�� Are you going to operate this business personally? _� YES 1�T0 If not, �� �3 operate it1 Q y��1�� \0 � F"ust�z�ae Hoac Address: Stroct \aye VfidZSeSnilixi (�.eidn) City I,rst State Dstc ofBvlL Zip Pione \*umSer Areprn3 g�s.e :e h�� e a-W�;z�e; or vsi��:t in L;s b:_�_ ess? YES ' if ;I:e r±&�ager is not t'�e s_. zs ;ne operztoi, p;ezse cou ple,� the ioile�aing info,=.,a:ioa: First`�me :.5dd{eLtitizi (�Qzid:n) ?ast DztcofBixth t-iome Addass: St�-t \zye Ciry Siste Zip Phoac \�bct List all other o�ce-. s of the coiporation: Of'f'ICER TITLE HO?v� HO?�fE BL'SL'vESS ?�TAT�/Ei (Qmce Held) ADD?2ESS PHONE PHOI�TE �"�i/l�'L�-Zi If business is a parmership, please include the following in{o�ation for each par�er (use additional pages if necessarg): � / i . / • _ /J/IO ��fi-r„ . (-Maidrn) HomeAddrw: Stm[]vame City I,ast State DA�EOF BII2TH f'�' , Da4 0: F'usttiame ?.SiddleInitid (�✓aidrn) I.ast DatcofBirth Home Addreas: Streec?��e Ciry State Zip PFione I�'umber MIDINESOTA TAX IDENTIFICATION N[IMBER - Pursuant to tim Law•s of Minnesota, 1984, Chapter 502, A:ticle 8, Section 2(270.72) (T'ax Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax identification number and the social secutity number of each license applicaat Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we aze tequired to ad�nse you of the followang regarding the ese of the Minnesota TaY Ideatification Niffiber: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's wzthholding or moior ve7vcle excise tvtes; - Upon receiving tLis information, the lieensing authority wiU supply it only to the Minnesota Department of Revenue. However, under the Federai Exchange of Information Agreement, the Department of Revenue may supply ttns information to the Iatemal Revenue Seivice. Mwnesota Tax Id�tificarion Niffibas (Sales & Use T�c Number) may be obtained from the State of M'innesota, Business Records Department, 10 River Park Plaza (612-296-6181). . Social Security IvTUmber. �G K"` 1 �(' � 1� Minnesota Tax IdentiScaUOn Number: � L"'fe� � O� _ If a Minnesota Tax IdentiScauon Number is not requ'ved for the business being operated, indicate so by placing an "X" in the box �:. �r ` 2/7 8/97 Please lis! }•os emp]o}ment history for tt�e pre�:ois fi�e (�);�ear pr.iod: `t8 -'ty3 CERTIFICATION OF WORiCERS' CO?�iPENSATIODi COVERAGE PURSUANT TO'J�?QESOTA STATU'IE 176.582 I haeb}' certifi� �hat I, or m� comp2�y, ain in compliznce �3ith the ��nrl:�s' compensalion vsurznce coverage requirements of Mianesota S a7:te l i6.182, subdi�;son 2. I zLso ti*�dr, s�d thzt p*o�isim of fise izafo, in this certificalion constitutes suuticient grow�ds for ad� erse xclion z¢air.st all licet:ses held, includir.g reti�ocztion and suspr.:s:oa of szid licznses. \TZme of U�serznce Compzny: PolcyNumber: Co erag, I hz� e no e;*ipio�'ezs co�•erzd under �ror!:ers compeasztion ssuzn (I?�ZTI�'aL.S) A1�Y FAISIFICATION OF �\SWERS GIVEN OR 1S.ATERiAL SIIB141TTTED �II,L REStiLT LY DE\TAL OF TFIIS APPLICATION I hereby state that I�a��e znsu ered a11 of Lhe preceding quzstions, and that the i. f'ormatioa contained hr, ein is true and cor, ect to the best of my ]rnou9edge and belief. I hereby state further fhat I ha��z recei��ed no mone}• or other co;isideration, by wzy of loan, gift, coasibution, or otheiuise, othe; than aheady disclose3 in the applicztioa aiuch I herev�ith sub:nitted I also understand tlus premise may be inspected 6y� police, fue, hezt �u z�d o��er ci;�� officizls 2t xny z�d zil tir.±es u�hen Lhe bi:�i*3zss is in o�e:2tie�. -C�� Date We Aill accept pz��ment b�• cash, check (made pzy�a6le to Cit� of Saint P�vij or credit card (1'UC er \'isa). IFPAYINGBYCREDITCARDPL£ASECOMPLPTETHEFOZLON'INGINFORMATION: � MasterCazd � Visa EXPIItAI'IOI�T DATE: � � � � ACCOUNf NUMBER: � � � � � � � � � � � � � � � � Date *'Note: If flus appiication is Food/Liquor related, please contact a Ciry of Saini Paul Health Inspector, Steve Olson (266-9139), to reenew plans. If any subs[antial cbanges to structure aze ancicipate,� please contact a Ciry of Saint Psul Plan Examiner at 266-9007 ta apply for building peimits. Ifthere are any changes to the parking lot, floor space, or for new operations, please contact a City of Saint Pau1 ZAning Inspector at 266-9008. Ali appGcations mquim the following documents. Please attach these documents when submitting your application: 1. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The following data should be on she site plan (preferably on an 81l2" x 11" or 8112" x 14" paper): - Name, address, and phone number. - The scale should be stated such as 1"= 20'. ^N shouid be indicated toward the top. - Piacement of all pertinent features of the interior of the licensed facility such as seating azeas, Idtchens, offices, repair area, parking, rest rooms, etc. - -If a request is for an addition or expansion of the licensed facility, indicate both the cwrent area and the proposed expansion 2. A copy of your lease agreement or proof of ownership of the propertp. SPECIFIC LICENSE APPLICATIONS REQUIItE ApDTTIONAL I,1'FORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> ; £3� v�s,9�