89-1126 WHITE - GTV CIERK I
PINK - FINANCE G I TY O A I NT PA U L ; Council A
CANARV - DEPARTMENT /_// �
BLUE - MAVOR File NO. V
Counc l Resolution �
��
Presented By
Referred To Committee: Date ���1
Out of Committee By Date
RESOLVED: That application (ID 89 2) for a Gas Station License with
21 Additional Pumps, 3 Grocery License and a Cigarette
License by David M. K o DBA Hazel Park Amoco at
1200 White Bear Avenu , and the same is h�reby approved.
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COUNCIL MEMBERS Requested by D�partment of:
Yeas Nays
Dimond �
Long �tl VO
Goswitz
Rettman
Scheibel � _ A ga n s t By i
Sonnen
�
� —6 Form App oved by City Attorney
Adopted by Council: Date ! - ��c
Certified Ya s d Counci , cr By �/ S� a i
gy. '
t#ppro by Mavor: �" w� _ 7 9 Approved by Mayor for Submission to Council
By
��i� J U L 1 � 1989
, ' � �-�r��
OEP �NT FFICEICQI�NdI • DATE IN TE
�"inance%�icense . GREEN SH ET No. 1 8 � 7
INITI DATE INITULIDATE
CONTACT PERSON 3 PHONE pEpqpTMENT DIRECTOR CITY OWNqL
Chri sti ne Rozek/298-5056 � g��A��, CITY CLERK
MUBT BE ON OOUNdL AOENDA BY(DA7'� ROUTI �BUDQET DIRECTOR �FlN.Q MOT.SERVICES DIR.
6-20-89 �MAYOR(ORA8818T 0 Council R search
TOTAL#�OF 81GNATURE PA(iE8 (CLIP L CATIONS FOR SIGNATUR�
AC710N REQUE8TED:
Approval of an application for G s Station License w th 21 Additional Pumps,
an A-3 Grocery License and Ciga et License.
Notification Date: 6-2-89 Hearing Date 6-20-89
RECOMMENDATIONS:Approve(A)a Rejsct(F� COU L C MITTEE/RESEARCH REPORT O IONAL
_PLANNINO COMMISSION —qVIL SERVICE COMMISSION ��Y PHONE NO.
_pB OOMMITTEE _
COMME .
_STIIFF —
_DI8TRICT OOURT —
SUPPORTS WHICH OOUNqL OBJECTIVE?
INITIATINQ PR08LEM,18SUE,OPPORTUNffY(Who,What,Whsn,Where,Why):
David M. Kroona DBA Hazel Park mo o at 1200 White Bea Avenue requests
Council approval of his applica io for a Gas Station icense with 21 Additional
Pumps, an A-3 Grocery License a d Cigarette License. All fees and applications
have been submitted. All requi ed divisions - Fire, H alth, Zoning, Police & Licensi g
have given their approval . !
ADVANTA(iES IF APPROVED:
DISAOVANTAt�E8 IF APPROVEO:
DISADVANTAOEB IF NOT APPROVED:
Coc:;-�c�l �e�e�rch Center
J�Pd 0 6 'i��J
TOTAL AMOUNT OF TRANSACTION s COST/REVENUE dUDGET D(CIRCLE ON� YES NO
�Np�N({�p(� ACTIVITY NUMBER
FINANqAL INFORMIITION:(EXPWI�
--.— -: � : ,:
, � g�' /�a�
T�iVISION OF LICENSE AND P�RMIT ADMIN ST TION llATEi y � � / r ! � " /
INT�,RDF.PARTMFNTAL KEVIEW GHECKLIST A.ppn roc ssed/Received by
' Lic Enf Aud
Applicant �-/Gl✓� � �� �✓�(� ►�1 Home Address I�j �� � �-� • i-i��ahS K �
Rus ine s s Name �U �e( �� Home Phone I �� �J — �� 7 � ��
Business Address v � �t A ���Pype of License(s) C1l{5 J��C-�v�l� � a�
Business Phone �7 °� � � X 7 f'1" C,Qi� C� U-►'e��
Public Hearing Date � —Z� —� 1 License I.D. �l ! � ���
at 9:00 a.m. in the Council Chauiber , G
3rd floor City Hall and Courthouse State Tax I.D. '�� �p � �'J/ 7 D�
llate Notice Sent; Dealer 4l I �1�"
to Applicant —o?� '
rederal. I'irearms �6 /v��
Public Hearing ' —T
DATE Ir PE TIUN
REVIEW VERFIED CO UTER) CUMMENTS
A proved No A roved '
�
Bldg I & D �
�(� g� , o ��. .
Health Divn. ' O�� I
������ � :
! �U ShS,�e�f" S ZZ�
Fire Dept. � �I Ir,� � �
! ► {S� }� re. �(�pn%u A'� G'► ��.er �;` � 1 �
j � ,
! - I
Police Dept. 5 ���I � ���
I
License Divn. j ; ��<
��� �
City Attorney � � � �
l�`7 � �'`I� '�
Date Received:
Site Plan �P�� l e0.S E'_ ', / �i
To Council P.esearch l� � 0
Lease or Letter � � Da e
from Landlord � �
: . � c,� �9-��a �
. � ' � CITY OF SAINT PAUL
�DEPARTMENT OF FIN C AND MANAGEMENT SERVICES
LICENSE PERMIT DIVISION '
These statement' forms are issued in duplic te Please answer all questions fully and completely.
This application is thoroughly checked. q alsification will be cause for denial.
1) Application for (type of Iicense) � _ c �1
2) Name of applicant �, � (�S1 ,� �•
3) Applicant's title (corporate officer, so e owner, partner, other) �.� L�x��r
4) Name under which this business will b c nducted: '
� =, G� � -., r10. �C.- `� � �
Applicant / Company Name Doing Business As
5) Business telephone number _
6 If a licant is/has been a married f , list maiden namel
) PP
7) Date of birth ��; „h� +-� f �� ge �p Place of birth ��- �C�.r.�,�
I
8) Are you a citizen of the United Stat s? � Native Naturalized
9) Are you a registered voter? �S ere? S�S���I �e,�,J
10) Home address j� � S � �� - �iome Phone �1�3 - �y1 �
I1) Present business address �ZC�C� W .�2� Q, ic '� Busi�ess Phone �1Z,_\��`(�
12) Including your present business/empl ym nt, what business/employment have you followed for
the past five years. I
Business/Employment Address
.
"� ��. � �Jhz�\(�c.� �� �
' �-s �� \tcG\ n. `���\\, � c,
� � �� l��s �:�?����br�.� ��
13) Married? � _ If answer is "yes" 1 st name and address of spouse.
14) Have you ever been arrested for an o fe se that has resulted in a conviction? �('�
If answer is "yes", list dates of ar es s, where, charges, confictions, and sentences.
Date of arrest , 1 Where
Charge I
Conviction Sentence '
. . � ��-//�G
Date of arrest , 19 Where '
Charge _
Conviction Sentence
15) Attach a copy hereto of a lease agree en or proof of owners�iip for the premises at which
a license will be held. '
16) Attach to this application a detailed de cription of the de ign, location, and square
footage of the premises to be license ( ite plan) . �`1 �.Q.C_Lr�
17) Give names and addresses of two perso s ho are local reside�nts who can give information
conceming you. I
Name Address
��C!E7\eu:�.`
r ��'�_ '� L.2 \�°�(� ��-Pr��;�c �`�\�.�
' �l�;ZcS �-\c��,;�c�C'� �`� �G.�c�C���
' SS����
18) Address of premises for which License or Permit is made.
Address 1 " �-p C Zone Classification �,
19) Between what cross streets? \ � ,Which side of street?
, S.�. �jt c�e.; G�'
(�..c-y��.�a•� '�;ti��e.�.as-
20) Are premises now occupied? «p S �;�
��--
What business? CG� How long? �,�� ;-S
21) List license(s) , business name(s) , a cation(s) which you currently hold, formerly held,
or may have an interest in, and loca io of said license(s) .
C � G � T�
� , � , � - � •\ � '� �h�
��\\c.cesk ���-�<<ac� �,; �e� C�=
22) Have any of the licenses listed bq q u No. 21 ever been evoked? Yes No �_
If answer is "yes", list dates and r as s.
23) Do you have an interest of any type n ny other business o business premises not Iisted
in 4�21? Yes No � If answe i "yes", list busine�s, business address, and tele-
phone number. '
24) If business is incorporated, give da e f incorporation �G'�' ��;1Cc�C D. � 19
and attach co of Articles of Incor or tion and minutes of! first meetin .
. , � C.� S�r-i� a �
,
25) List all officers of the corporation g vi g their names, office held, home address, date
of birth, and home and business teleph ne numbers.
^ C '
26) If the business is a partnership, list pa tner(s) address, phbne number, and date of birth.
�
27) Are you going to operate this business pe sonally? If not, who will operate it?
Give their name, home address, date of bi th, and te hone number.
28) Are you going to have a manager or ass st nt in this business? � If answer is "yes",
give name, home address, date of birth a d telephone number.l
\ ' �.. `� � � �'l\- `� \
29) Has anyone you have named in questions �2. through 4626 ever t�een arrested? �_ If answer
is "yes", list name of person, dates o a rest, where, charges, convictions, and sentence.
30) I un erstand this premi es may be inspected by the
Police, Fire, Health, and other citq o fi ials t any and a11� and all times when the
business is in operation.
State of Minnesota )
� �
Count df Ramse ) ig ature of Appl cant Date �
�
n ° � C �
I,G be ng duly sworn, deposes and says upon oath that
he has read the foieg ng statement be ri g his signature and knows the contents thereof,
and that the same is true of his own ow edge except as to those matters therein stated
upon information and belief and as to ho e matters he believes them to be true.
Subscribed and sworn before me
t C� �.�;,+Wo��ca;.�.���*raeu�+�cv�;
h s � a y of , 1 , �M"'''µ'^°.�'';,_ .._ . . .. :-^°���.;_���?��: �
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a � y��
a. ci�� �' ��vi� ,� l.+Vli1�17
� �' �''����•' 6Ay Commission Ezpires Mar.21.1991
Notary Public, � o ty MN
My commission expires Rev. 2/88
• � � I � ��r // � � ..
' ` ity of Saint Paul
� ' • Oepartment of in nce and Management Services ` ,�? ��-�*�-.�
Lic se and Permit Division
203 City Halt
St. P 1, innesota 55102-298-5056
APPLI A ION FOR LICENSE
CASH CHECK CLASS NO. ew Renew
ao 0 ,�/ �
��
Date 7-/ -- t9�
Q <y
C�e No. Title oi License From � � ;> 19��To � `'�/ 19�
��� �/ / 'q !�'� '�r \ �� �
�<<-� �oo r � 1 ,c x_��
� �� „� 5 '� �+ �` �'- (�(i Appliean p ny Name
� �3 �, - ` 100 �/ /, ` �� �1 ��� ' r �
-- �
f 100 � Businss�6 Name " �
:��i � - ' , , � C;L � �;'—S `
b �<<<, t;° � G/�/�C� �_� �^'L//�/ � �f74
� / \ : �W �rI% �I � �'� �/l�l i / // /� f .
\/ il T
Busfness Adtl�ess Phon�No.
100 ,
100 Maii to Address Phons No.
100 '
MsnaperlOwmer•Name
100
L
100 AtanapenGwner•Home Addreaa Phons Na
4098 AppNwtio� FN 2. � I
Recetved the Sum of 100
_ Q C, ManapenOw r•Gty,stats a z+v Cods
100 ota 100
� �
Ucense InspeCtor By: ` , Sig�ature ol Applicant
Bond:
Company Name Policy No. , Expintbn Oale
Insurance•
Company Name Polley No. I Expiratfon Oat�
M(n�esota State identification No � `� G�� Social Security No.
Vehicie Informatfon:
Serisl Number alt umbN
Other
THIS IS A R C IPT FOR APPLICATION
THIS IS NOT A UCENSE TO OPERATE.Your application for lice se will either be grartted or rei�cted subiect to the proviaions of the zonin�
ordinance and eompletlon of th�inspections by the Health Fir Zoninq andlor licenss InspeCtors.
,
$15.00 CHARGE R LL RETURNED CHECKS ' a ��-
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