87-1269 WHITE - CITV CLERK
PINK - FINANCE G I TY .OF SA I NT PAU L Council �f
CANARV - DEPARTMENT 7 /
-� BI.UE - MAVOR . Flle N0. / �/o�C��
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Council Resolution - �
Presented By -���
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Referred To Committee: - Date
Out of Committee By Date
RESOLVED: That Application (I.D.#76634) for a Massage Therapist License
applied for by Boris Belichki DBA Professional Massage Center
at 734 Grand Avenue be and the same is hereby approved.
COUNCILMEN Requested by Department of:
Yeas Dr'eW Nays
Nicosia ? (n Favor
Rettman
Scheibel
Sonnen � Against By
4Veida
W7.130ri �7Cf — 1 1987 Form Approved by City Attorney
Adopted by Council: Date
Certified Pass by C uncil Sec ar BY
sy�
Approved avor: Date _ � � Approved by Mayor for Submission to Council
By �� By
Pt��� ����' 1 � 1987
, � C�z� Pd I �� l�� �r--��� ��
� DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE 0 f �, � ��
INTERDEPARTMENTAL REVIEW CHECKLIST
Applicant�j C�r, � � j;�1�C� Home Address 13c� U t5 �`,�- •�'i� •��`�
. �(o3ct
Bus ine ss Name S ��i.��� �Q`;,,;�r��rr���,m�,�,a-,_��,Home Phone (4 I a - �Sa- 1�, �-1 L�- S-�,. .���
� ' C�.-� . �
Business Address �,�c.� ���,.���_ 1�-0- Type of License(s) "�c�.��,
Business Phone p� a�6 - �4�1 I {�Ce��
Public Hearing Date I � License I.D. # �I `�D l�- 3�
at 10:00 a.m. in the L������ers,
3rd Floor City Hall and Courthouse State Tax I.D. �
�
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER) COPIl�IENTS
rAVed NOt ed
Housing & Bldg �
Code Enf orcement °�I � � l �c,.�. �
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Public Health �l � '� � 2� I
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Fire Prevention �� �
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Police �� �
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City Attorney �� �
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300 Foot Notice I
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License Inspector's Comments:
I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRED.
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CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
. ', CITY OF S'i. PAUL �'�-��(py
' �� ' DEPARTMENT OF FINANCE AND MANAGEMENT SERVICES
' LICENSE AND PERMIT DIVISION
Please answer a11 questions fully a.nd completely. This application is thoroughly checked.
Any falsification will be cause for denial.
Date , � a2� 19�7
1. Application for L1 C2�LSe . Z �+�SS� � P 2�- i J � �Llcense)�Permit)
2. Na.me of applicant � 0/� 1 .S /.3 � L. .L C��I
3. If applicant is/has been a married female, list maiden name �
4. Date of birth /`��� S /�ge 3 y Place of birth i a — �-�� �� �-2�a-
5.. Are you a citizen of the United States Native Naturalized �/
6. Are you a registered voter�0 _Where
7. Home Address /.3..2� �� �6c �Z: /'' , � ��'�/ Home Telephone 6IZI�s1-6�7��j
S¢- C���- , /�/� S6 3��
8. Present business address �h 2".c � o c z�� Business Telephone
9• Including your present business/employment, �rhat business/employment have you
followed for the past five years.
Business/employment. � Address
o z.�-e z � �l C /2 f� �' /3 00�.o��.,�.si �x�--�
,
p � /.�u���'-O��� .��-t��a,s,r J�i1� �:1 Cy'cr z i o�
/ /� SC�C-rrc>c!�!.
10. Married � es if answer is "yes", list na.me and address of spouse ����Sf�a..
/� � /� / /. /J
eG!`e �c�' C���'m�` �.'r'.�+1.c�._zoti 4�% - „Z80d -�tKOL�as��( - �• t7c Lr�c�
11. If this application is for a M assage Therapist License, Iist time so occupied.
Years Months.
12. Have you ever been arrested `t0 If answer is "yes", list dates of arrests, where,
chaxges convictions and sentences.
Date of arrest 19 �ere
Charge
Conviction Sentence
Date of arrest 19 Where
Charge
Conviction Sentence
. � • (;��-!��y
13. Give na.mes 3.nd �.ddresses of t�o persons, residents of St. Paul, Minnesota who can
give ?nfor�ation conceraing you.
�t�'� ADDRESS
Icts�vs T�x,�cS .?3 `7s vl�va��'o�� s1� f�;�� ,�Scr,�.f� /y/�''
,7��v!w �c�c�e✓ 3�3 O�c� so � �' 3D�l �e,,r /�z,' ��t�-
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State of Minnesota )
) SS
County' ° Ramsey
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� ' -�-� being first duly sworn, deposes and says npon oath
that e has read th �oregoin� statement be�,ring his signature and knows the contents
thereof, and that the sane is true of his own knowledge except as to those matters
therein stated upon information and belief and as to those matters he believes them
to be true.
S cribed and sW rn to efore �ae �oz�s ��e�i�GL�Gr
Signature of Applicant
+ ' s a day o 19�
� --- � � fr�
Plotary Public, Ramsey County, Minne �a
My Commission expires ��•�•��•.. r��R�F �� a r_ sCHILLINGER
.,:u....:..
..�,1!�p�`� NOTARY PUOIIC—MINNESOTA
��'F�� RAMSEY COUNTY
•`'`�T3�`� My Commission Expires Mar.21,1991
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------=--=----=---------------- AGEMUA ITEMS ---------------------------------
• ----------- ---------------------------------
ID#: C188 ] DATE �EC.: C08/20/87] AGENDA UATE:: C00/00/447 ITEM ##: C ]
SUFJECT: CMASSAGE THEkAPIST LICEN5E -- ROFIS HELICHI:I a
STAFF ASSIGNED: C ] SIG:C ]QUT—C ] TO CLERK:C08/�0/87]
ORIGIMATO�:CLICEMSE I�IVIISIbM ] CONTACT:C �
ACTION:C �
C �
ORD/RES #:C ] FILEI?:C00/04/00 ] LOC.:C ]
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FILE INFO: CRESOLUTION/CHEKCLIS7/ARPLICATIOM �
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