90-1137 O �{ � ��n� a � Council File � �-
� � � IYi-1 10581
Green Sheet ,�
RESOLUTION .-�`��;
_ CITY OF SAINT PAUL, MINNESOTA �'�_ �'.,
;
Presented By
Referred To ittee: Date
RESOLVED: That Application (I.D. ��52548) for a Massage Therapist License applied
for by Deborah L. Peterson DBA Medalist Sports Club II at 1515 Brewster
Street be and the same is hereby approved.
Y�_ Navs Absent Requested by Department of:
zn on
o w '�1`-
o License & Permit Division
acca ee
e m
u e
z son �` '-7`— BY�
Adopted by Council: Date �U� 5 19�0 Form Approved by City Attorney
Adoption Certified by Council Secretary gy: ,� �j �7�V
By� ��'// �'�"'"-'�''('Q'�✓ Approved by Mayor for Submission to
Approved b Mayor: Date �U�. 6 �9� Council
�.�'��z� By:
By: �
Pl1BllSNED J U L 14 1990
� = ��-��3��-
DEPARTMENT/OFFICFJCOUNCIL DATEINITIATED GREEN SHEET �`O -10581
Finance/License INITIAUDATE INITIAUDATE
CONTACT PERSON&PHONE �DEPARTMENT DIRECTOR �CITY COUNCIL
�Y'1S Van Horn/298-5056 ASSIGN �CITYATfORNEY �CITYCLERK
NUMBER FOR
e r n��a�x�eGE jo�BYt��O� ROUTING �BUDGET DIRECTOR �FIN.8 M(3T.SERVICES DIR.
115� �2gt0 l,0UIIC11 �y: ' � ORDER �MAYOR(ORASSISTANT) � , R
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REOUESTED:
Application (I.D. f�52548) for a Massage Therapist License
RECOMMENDATIONS:Approve(A)or Re}ect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWINO QUESTIONS:
_PLANNINO COMMISSION _ CIVIL SERVICE COMMISSION �• Has this person/firm ever worked under a contract for this department?
_CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a city employee?
_STAFF — YES NO
_DIS7RIC7 COURT _ 3. Does this personlfirm possess a skill not normally possessed by any current city employee7
SUPPORTS WHICH COUNCIL OBJECTIVE? YES NO
Explain all yea answers on saparets shsst end attech to gra.n shest
INITIATINCi PROBLEM.ISSUE,OPPORTUNITY(Who,Whet,When,Where,Why):
Deborah L. Peterson DBA Medalist Spoxts Club I�i requests Council approval of her application
for a Massage Therapist License at 1515 Brewster Street. All applications and fees of
$83.50 have been submitted. All required departments have reviewed and approved this
application.
ADVANTAGES IF APPROVED:
DISADVANTAGES IF APPROVED:
DISADVANTA(iES IF NOTAPPROVED:
COLIIIC�� �����#'6�1 Cr@11t�
���;�� � � ►��y
., ,�_�
TOTAL AMOUNT OF TRANSACTION 5 COST/REVENUE BUDGETEp(CIRCLE ONE) YES NO
FUNDIN(i SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN)
. .,
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO. 298-4225).
ROUTING ORDER:
Below are correct routings for the five most frequent types of documents:
CONTRACTS(assumes suthorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept.Grants)
1. Outside Agency 1. Department Director
2. Department Director 2. Ciry Attorney
3. Ciry Attorney 3. Budget Director
4. Mayor(for contracts over$15,000) 4. Mayor/Assistant
5. Human Rights(for contracts over$50,000) 5. Ciry Council
6. Finance and Management Services Director 6. Chief Accountant, Finance and Management Services
7. Finance Accounting
ADMINISTRATIVE ORDERS(Budget Revision) COUNCIL RESOLUTION (all others, and Ordinances)
1. Activity Manager 1. Department Director
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor Assistant
4. Budget Director 4. City Council
5. City Clerk
6. Chief Accountant, Finance and Management Services
ADMINISTRATIVE ORDERS(all others)
1. Department Director
2. City Attorney
3. Finance and Management Services Director
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and paperclip or flag
each of these pages.
ACTION REQUESTED
Describe what the projecUrequest seeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
a verb.
RECOMMENDATIONS
Complete if the issue in question has been presented before any body, public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objective(s)your projecUrequest supports by listing
the key word(s) (HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET,SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
PERSONAL SERVICE CONTRACTS:
This information will be used to determine the city's liability for workers compensation claims,taxes and proper civil service hiring rules.
INITiATING PROBLEM, ISSUE, OPPORTUNITY
Explain the situation or conditions that created a need for your project
or request
ADVANTAGES IF APPROVED
indicate whether this is simply an annual budget procedure required by law/
charter or whether there are specific ways in which the City of Saint Paul
and its citizens will benefit from this projecVaction.
DISADVANTAGES IF APPROVED
What negative effects or major changes to existing or past processes might
this projecUrequest produce if it is passed(e.g.,traffic delays, noise,
tax increases or assessments)?To Whom?When?For how long?
DISADVANTAGES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved?Inabiliry to deliver service?Continued high traffic, noise,
accident rate?Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addressing, in general you must answer two questions: How much is it
going to cost?Who is going to pay?
. �; �=-yo,,�37
DiVISION OF LICENSE ANn PERMIT ADMINISTRATION DATE ��_� /
INTERPFPARTMENTAL REVIEW CHECKLIST A.ppn Processed/Received by
Lic Enf Aud
Applicant � Q�j�r���_�R.V��_ Home Address ��i� �. o� ��r
Rusiness Name �(,�1��5�Spp(� � Home Phone y� - 3-l �g
Business Address lS i� `j��5�r �, . Type of License(s) rn�1�c,C,� ���pi�
�.
Business Phone �(.p- (�(p5
Public Hearing Date "��5'��(� License I.D. 4{ 5��� b
at 9:00 a.m. in the Council Chambers,
3rd floor City Hall and Courthouse State Tax I.D. 4� a g 3��a i
llate Notice Sent; Dealer 4� Yl (A
to Applicant � � 02.� !� O
rederal F�xearms 4� Y� �
Public Hearing
DATE IrSPECTIUN
REVI�,W VERFIED (COMPUTER) CUMMENTS
A proved Not A roved
�
Bldg I & D
(.e( �-s !
O�
Health Divn. '
, '�r:� � ! U�
�
Fire Dept. �
i � l�, � � � � �
� �
Yolice Dept. ' I
l..P� IS (� �
�
License Divn. '•
l� l r�' � o h
City Attorney ;�/�1 �
` ��l
�
Date Received:
Site Plan �� �Q,,
To Council Research
Lease or Letter Date
from Landlord
� � �
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bo�la:
Workers Compensation: -- -
New Officers:
Stockholders:
. �. . � �-90_,,,��
, � CITY OF S'i. PAUL
DEPARTMENT OF FINANCE AND MANAGF,MENT SERVICyS ,
LICENSE AND PERMIT DIVISION
Please a.aswer a11 questions �].ly and completely. This application is thorough� checked.
Any Palsification will be cause for denial.
Date � � 19�Q
1. Application For � �c r H�� � �k � � ��t" _ (License)�Permit)
2. Name of applicant ��� 1n r r-c�� l- ��' � �' r•� : �
3. I£ applica.nt is/has been a married female, Iist maiden name � �'-'kc� ✓' � �!%'�
k. Date of birth�,�` �,Age '�%.�- Place of birth j-} �i��l i�'� r Yt r� •
5. Are you a citizen of the United States I/t'S Native�.' __Naturalized
�
6. Are you a registered voter \/t'S _�ere � 1� - ��-�
-7-- _ �
7. Iiome Address �'7` ,� „L:l � • ��r �^ �l,'�����.� �^ �� II_�_Home Telephone� � �
8. Present business address�����t�'c,c.)�� Y� ���0� Business Telephone����os--
9. Including �rour present business/employment, uhat business/employment have you
foilowed for the past five years.
Business/employment. Address
� — � / ��
�l.r,�r'��,-, f�;vr��_ �J�r � �2 ��r �
�. , _
� �H T�,���= �L l , �, � � ,
> >- � �-�
10. Married�iP ansWer is "yes", list name and a.d�.ress of spouse
� i � ���� � �c� ►� 'c T, t���,r�r� �� � � S- ( � 3
�li 1 � � � ��C1��0 ✓� � L
- J
11. I£ this application is for a Massage Therapist License, Iist time so occupied. �
� � .�
'�irvr i S �1 P c(_ �`'r���c, u r��� ' � ' '
12, Have you ever been arrested , �� . IP aasver is "yes", list dates oP arrests, where,
charges convictions a.ad seatences.
Dat of arrest 19 Where
Chaxge
Coaviction entence _
Date of arrest 19 r°
Charge
Conviction -- Senteace
. ^ . ��o i/3 �
13. Give names and addresses of two persons, residents of St. Paul, Minnesota Who can
give information concerning you.
NAME . ADDRESS
—
� ���,��,�: �-, r P�' ���e S�-( U `f
e ►� ' ,��� I �( r�� wi� c� �.� )�"l I -7
State of Minnesota )
) SS
County of Ramsey )
--� ;,�
• �- � �, - _ �' ;" +., ,� ; �peing first duly sworn, deposes and says upon oath
that he has read the foregoing statement bearing his signature and knows the contents
thereof, and that the same is true of his oWn knowledge except as to those matters
therein stated upon information and belief and as to those matters he believes thea
to be true.
� � � �� ��
Subscribed and sworn to before me � � _ ��j�'`%���i'���r� ��� � � ���-�-�'��V
� .. -
` " Signature� of Applicant
this_ b day of��(Yln�,,, 19�'t,�
,��. _ �� �j .
.,, . . i ,.�v,.,r,•�n.�,,.�:�,�ti
Not ry Public, y County, Minnesota �i;1 KRI�TlNA I. V�N a�i;���
�-�-- ��NOTARY PUBUC-1dINNES�7a
rty Commission expires �,,.� �, t 4� • OAKOTA COUNTY
MY�Co�m�mission Exprres Jan. ? �
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