87-1483 WMITE - CI7V CL€RK COI1flC11 � , /Q-
PINK - FINANCF� C I TY OF SA I NT PAU�L 1 / 3
CANARV - DEPARTMENT �y ./�L�.! �
BLUE � - MAVOR ' . Flle NO• • � ��
� I
Cou il Re lution
��� ♦ 9 .'���� iy �.
C�'-
Presented By _
Referr�d To Committee: Date
Out of�Committee By Date
I
I
RESOLV�D: That Application (I.D.#37328) for a Massage Therapist License applied for
by Barbara Zawislak DBA Sister Rosalind's Professional Massage Center
iat 734 Grand Avenue be and the same is hereby approved.
I
I
I
I
I
COUNCI MEN
Yeas preW Nays Requested by Department of:
Nicosi �
Ret� In Favor
Scheib�l Cy Against BY
Sonnen
Weida
Adopted b�y Co1u cil: Date �CT - � 198� Form pproved by C ty t ey
/
� r
Certified Pa s y o ncil Se ar BY � ,
sy
t\ppro y Maaor: Date _ � Approved by Mayor for Submission to Council
By BY
, PllBl��� U G i i `E" ����
- HOW TO USE THE GREEN SflEET � •
� � � . ,..•,� c�.w_4
The GREEN SHEET has three PURPOSES: . �
1. to assist in .rauting docwnents and in securing required signatures;
2. to brief the reviepers of documents on the impacts of approval;
3. to help ensure that necessary snpporting materials are prepared and, if required,
� attached. .
Providing complete information under the listed headings enables reviemers to make
decisions on the documents and eliminates follow-up contacts that may delay execution.
Belo�r is the nxeferred ROUTING for the five most frequent tYpes of documents: .
CONTRACTS (assumes authorized budget exists)
1. Outside Agency 4. l�ayor
2. Initiating Department 5. Finance Diractor
3. City Attorney 6. Finance Accounting
Note: If a CQNTRACT amount is less than $10,000, the Mayor's signature is not required,
if the department director signs. A contract must always be signed by the outside agency
before routing through City offices.
ADMINISTRATIVE ORDER (Budget Revision) ADMINISTRATIVE ORDER (all others)
1. Activity Manager 1. Initiating Department
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor/Assistant
4. Budget Director 4. City Clerk
5. City Clerk
6. Chief Accountant, Finance and Management Services
COUNCIL RESOLUTION (Budget Amendment/Grant Acceptance) COUNCIL RESOLUTION (all others)
1. Department Director 1. Department Director
2. Budget Director 2. City Attorney
3. City_Attorney 3. Mayor/Assistant
4. Mayor/Assistant 4. City Clerk
5. Chair, Finance, Mgmt. � and Pers. Cte. 5. City Council
6. City Clerk
7. City Council
8. Chief Accountant, Finance and Management Services
The COSTLBENEFIT. BUDGETARY. AND PERSONNEL IMPACTS heading provides space to escplain the
cost/benefit aspects of the decision. Costs and benefits relate both to City budget
(General Fund and/or Special Funds) and to broader financial impacts (cost to users,
homeowners, or other groups affected by the action). The personnel impact is a description
of change or shift of Full-Time Equivalent (FTE) positions.
The ADMINISTRATIVE PROCEDURES section must be completed to indicate whether additional
administrative procedures, including rules, regulations, or resource proposals are
necessary for implementation of an ordinance or resolution. If yes, the procedures or a
timetable for the compietion of procedures must be attached.
SUPPORTING MATERIALS. In the ATTACHMENTS section, identifq all attachments. If the Green
Sheet is well done, no letter of transmittal need be included (unless signing such a letter
is one of the requested actions) .
Note: If an agreement requires evidence of insurance/co-insurance, a Certificate of
Insurance should be one of the attachments at time of routing.
ote: Actions which require Citq Council resolutions include contractual relationships
with other governmental units; collective bargaining contracts; purchase, sale, or lease of
land; issuance of bonds by City; eminer�t domain; asswaption of liability by City, or
granting by �City of indemnification; agreements with state or federal government under
which they are providing funding; budget amendments.
. . � �� . ������3
I DIVISIaN OF LICENSE AND PERMIT ADMINISTRATION DATE
INTERDFiPARTMENTAL REVIEW CHECKLIST
A licant � a� � �..�i� r;�_ Hame Address �('(j ; �� 432
!!
� . . � . . ~ _ . . . �
Bus ine s Name �,��,s�,,,��,�� •� (,�r . Home Phone S-1���'-1`��
Busine s Address I3�-� �f(�..c� > > Type of License(s) ��`� ,
Busines�s Phone ao`Z�'- i 5i � �.
Public IHearing Date �j�, , tp License I.D. # �J��J2�
at 10:00 a.m. in the Council Chambers,
3rd Flo�or City Hall and Courthouse State Tax I.D. # �?j3 �lS 1�
� �� � � � )
REVIEW ' DATE DATE INSPEC
APPN REC'D VERFIID COMPUTER COI�IENTS
�oved Not raved
Housingj & Bldg �
Code E forcement � � � � l �� �
I O
Public �Iealth � I � I L i
� � I
I
Fire Prleveation �
' �) � �' Ico I d�
I
Police �
�� i � �
City At'torney �
I
I
ENS 1
ni � �
300 Foo Notice I
� !� �
�
License; Inspector's Comments:
,
I HAVE � EEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUB�IC HEARING IS REQUIRID.
i
, .. ."..:�:'"_i.��l� � t � . .. .. .. .. .. - .�. . .. .. � � .. ....91.. .
�y7
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Current DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
. ��7—i�/�-3
' • ' I CITY OF S'i. PAUL
�� DEPARTMENT OF FINANCE AND MANAGF,MENT SERVICES
I LICENSE AND PERMIT DIVISION
Please a.n�wer a11 questions f�lly and completely. This application is thoroughly checked.
Any falsi�ication will be cause for denial.
Date� / 19 g 7
l. Applidation for �1-S�A�„� ��l.to.` � �License)(Permit)
2. Name of applicant �j�1R��. (� Zrrc,vrS �fl-�
3. If ap�licant is/has been a married female, list maiden name �
4, Date �f birth/Oa /3 Age � 7 Place of birth�"�lS - �'1 /� ,.
5. Are you a citizen of the United State�Native Naturalized
6. Are you a registered voter'��} __Where_ e ,�r C'7'y— f-��y ��'►�
'T—
7. Home t�ddress �00— Q/� C��� ��l�4e� /V•� � Home Telephone ,S7f.�,7yc�
p�S- • s�.
8. Prese�t business address Business Telephone
9. Includ.ing your present business/employment, what business/employment have you
followed for the past iive yeaxs.
�usiness/employment. Address
�20 �s�,' �►,€-C �.�r°- 73� �.�� �u�. �- 7�r���/� _
_ � , ,
10. Mexri�ed if answer is "yes", list name and address of spouse
11. If th�s application is for a M assage Therapist License, list time so occupied.
Years ,� Months.
12. Have you ever been arrested �� If answer is "yes", .list dates of axrests, where,
chasges convictions and sentences.
Date pf arrest 19 �ere
Charg�
Convi!ction Sentence
Date of axrest 19 Where _
Cha.r�e
Convilction _ Sentence
I
, i ���`����
.. ' _
13. Give �a.mes and addresses o� two persons, residents of St. Paal, Minnesota who can
give infor�ation concerning you.
i
. ' NA1� ADDRESS
s R, ,�a s,f-1��,� � G.� �,� ��'�ss.�,�,}-Q �-s SA (' ,����.
� �,�l�,�.�� s�� v,�. ��. -
r4 y
State of �u,nnesota ) -
) SS
County of �tamsey )
� �fJG +Q U-� � �CL �.tJ / S �,q k being f�rst duly sworn, de�oses and says spon oath
+hat he na� read the foregoing statiement bearing his signature and knows the contents
thereof, a.rid th4t the same is true of his own knowledge except as to those matters
therein stated upon �nformation and belief and as to those aatters �e believes them
to be true,'
Subscribed land sGrorn to before me -
/� Si . at e of Applica.nt
this / � day of,�Jp��1�7
, ,
� '
luotar� u iic, " ounty, �finnesota
•�. JANfT A. ODALEN
My Commission e:rnires -��,;r� , , .,p �Tp
I I�� OAI(OTA COIkRY
2 MY COlNM.D(PIRES AUC.21. 1991
Y
i ,
�
I
i
i
.________�_______________________ AGENDA ITEMS =_______________________________ ����'��3
ID#: [293 ] DATE REC: [09/29/87] AGENDA DATE: [00/00/00] ITEM #: [ J
SUBJECT: '[MASSAGE THERAPIST LICENSE - SISTER ROSALIND'S MASS. CNTR/734 GRAND )
STAFF AS�IGNED: [NONE � ] SIG:[��T�'��l OUT-[ ] TO CLERK �OAfBE�fflE�} � `��
ORIGINATOR:[LICENSE DIV. ] CONTACT:[KRIS SCHWEINLER (5056) ]
ACTION:[ �
[ �
C.F.�,[ ] ORD.# [ ] FILE COMPLETE="X" [ ]
, � � � � � � � � � � � �
FILE INFO: [RESOLUTION/APPLICATION/CHECKLIST �
[
� 7
______________________________________________________________________________
., :
I , .
' v
� , • �,
. r--
_ r��
" � • v
:i
I