87-1521 WHITE - GTY CLERK
PINK - FINANQE G I TY OF SA I NT PA iT L Council
CANARV - DEPARTMENT 1 J��/''� ,'`7
BLUE - MAVOR . Flle NO. *�+ �—/` �
1
C c " Resolution ;-
Presen d ' � �
te By
Referred To Committee: Date
Out of Committee By Date
RESOL�TED: That Application (I.D.#74352) for a Massage Therapist License
by Mavis Doten at 734 Grand Avenue DBA Professional Massage
Center be and the same is hereby approved.
COUIVC[LMEN Requested by Department of:
Yeas DreW Nays �
Nicosia in Favor
Rettman
So�'� � Against BY
Weida
Wi15on �C+T 2 � �� Form Approv by i Attorney
Adopted by Council: Date
Certified Pass b uncil Secr $y t '
By
A►pprove 1�avor: Date �L� 2 i �$� Approved by Mayor for Submission to Council
By BY
P(�.�� n n 1 � 1 1987
—/�5��
•� � � . , .a.� �11420 ,
� DEPARTMENT .
�r�5 ' CONTACT NAl�
_�g F�- - s Cc , PHONE °
� � �- DATE . �
,
G D (See reverse side.)
_ Depart ent Director _ Mayor (or Assistant)
_ Financ , and Managemant Services Director � City Clerk r'�c.� ��j w.�,.^�rr�.^,.
_ Budget irector ,� �1,�. ._ _ `Q � ,,���a
,
� City At orney _
N U (Clip all locations for signature.) �
V C G ? (Purpose/Rationale)
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C S B N U A S IMPACT C D:
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N C G SO C C V E C E C DI D:
(Mayor's sig ture not required if under $10,000.)
Total Amoun of Trans�ction: �v \'�A Activity Number: n (�} �
Funding Sou ce: �l�
ATTACHMENTS: (List and number all attachments.)
�
'�-,�'F'1L`��.� •
�:a�
ADMINIS T V ROC III�
_Yes _N Rule,�, Regulations, Procedures, or Budget Amendment required?
_Yes _No If yes, are they or timetable attached�
DEPA Z T REV W CITY l4TTORNEY REVIEW
✓Yes No Council resolutioa required? Resolution required� v Yes _No
Yes �No Insurance required? Insurance sufficiant? _Yes _„No
Yes ✓No nsurance attached?
, ��7-�S�/
� DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE
INTERDEpARTMENTAL REVIEW CHECRLIST
Applicant �������P,� Home Address 3cjp��h.i,r��-Q
` ��Y��h r. L�t
Busines� Name�r , �r � .�.�. Home Phone
Business Address �„��n�n�,( (�U �5/ T�pe of License(s) _
Business Phone �g - 1� l �
Public H,earing Date � License I.D. # ��- 3� c7�
at 10:00' a.m. in the Council C ambers,
3rd Floor City Hall and Courthouse State Tax I.D. # 33�"t S�
1 c�
REVIEW DATE DATE INSPECTION
APPN REC'D VERFIED COMPUTER CO1rIl�iENTS
' �oved Not raved
Housing & Bldg �
Code Enforcement �I �� � � ,�� I
Public Health I
� � 2, / 5�( �c.f. I
`r �
I
Fire Prev�ention 4
�r z� �� ► � '
I
Police �
�� I� �� �3U �
City Atto�"ney �
!
I
ENS �
� 1� ;
300 Foot Notice I
n ��, '
►
License Inspector's Comments: �A ,� , „_D � �,
p
I HAVE BEEN GIVEN A COPY OF THIS NOTIFICATION AND UNDERSTAND THAT MY ATTENDANCE AT
THE PUBLIC HEARING IS REQUIRID.
: � ��sa�
, ' � • CITY OF S'i. PAUL
� DEPARTMENT OF FINANCE AND MANAGII�NT SERVICES
LICENSE AND PERMIT DIVISION
Please answer all questions fully a.nd completely. This application is thoroughly checked.
Any falsification will be cause for denial.
Date �19�
. 1. Applic�,tion for�/��¢SSA�'� TN E.Pi9 �/�? L/C��St _ icense)(Permit)
2. Name of applicant yJ�iq-!//S � 9 ?��N
3. If applica.nt is/has been a married female, Iist maiden name �/)')r9�d�S f�1'� ft7T��✓E�
�. Date of birth '�o'3j Age S�, Place of birth �L-� Q ��7, /Y� t�
5. Are you a citizen of the United States�Native�_Naturalized
6. Are you a registered voter y�G - Where��j ,�p o�L y rv � E N t �re- ✓1^ N
7. Home Address p O %�`T ��Z Home Telephone S�v �� d���
�s�..o� �.�y �E� � �iz... , �.�1p � � p
8. Present business address 7 3 `7- �/�4N� f�✓�'. S 1 T.Business Telephone v-a�p -/�/ /
��-a�FE'SS� orU � �S S�3-G-C- CE1•1 Tc�
9. Including yovr present business/employment, vhat business/employment have you
followed for the past five years.
Business/employment, Address
�c N E2/�i-L l`� � �-l_S . /�C,_ `�2-��J C?J�-`l 2%1' �/� .8 � �-� , �
�D c �7 c_L.C_.� � lr Wv
10, Maxried if answer is "yes", list name and address of spouse�(L�B�/Z.-7 !�{� K/c7 >C�
�D o/ T�+cJ�% �.�-- /�D �,e-�D��L`-f� �� � ��/l M� �S S ��
11. If this application is for a Massage Therapist License, list time so occupied.
Years � 1 � /YI v.v7//S hsonths.
12. Have you ever been arrested /v� If answer is "yes", list dates of arrests, �rhere,
chaxges convictions and sentences.
Date of axrest_ 19 Where
Charge
Conviction Sentence
Date of arrest 19 �ere
C:�axge
Convict�on Sentence
: � ���Sa l
13. Give names a.nd addresses of two persons, residents of St. Pau1, Minnesota wr,o can
give infor�ation concerning you.
V� ADDRESS
S�. ,� oS r L�nI /J G� F'i2� �� � ��4 1..1� /� (/�'" � ST��}-U L
S� . D� rv ti /� /.�R o� � �� �� �
State oi Minnesota ) -
) SS ,
County of Ra.tnsey )
�4t ,; � � n-��h being First duly sworn, deposes and says upon oath
t a�he has read the foregoing s�atement bearing his signature and knows the contents
thereof, and that the sam.e is true of his own �.nowledge ex.cept as to those matters
therein stat�d upon information and belief and as to tho e matters he believes t em
+.o be true. .
Subscribed and sworn to before me �
Signature of A plicant
thi s o� � day o f �G , 19�_
�- a
`,,�- . - J - . 1i ,.a `� � � �.� KAISTINA L.SCHWEINLER
�Vo axy Public, �ey�County, MinnesOta �+'.✓i� NpTARY PUBUC—���TA
`�C,.k..a �c i� oaK�ra��.2.��
My Commi.ssion exoires c� ��t �7 �� ��'IX�
.
__________°°'°-----°---_---- AGENDA ITEMS
----------------- ---- ________________________________ �7/s�/
� ID#: [308 ] DATE REC: [10/O6/87] AGENDA DATE: [00/00/00] ITEM #: [ ]
SUBJECT: [MASSAGE THERAPIST LICENSE - MAVIS DOTEN - 734 GRAND AVE. ]
STAFF ASSIGNED: [NONE ] SIG:[RETTMAN ] OUT-[X] TO CLERK -F88f00r7�0]/o�7/P��
ORIGINATOR:[LICENSE DIV. ] CONTACT:[SCHWEINLER - 5056 �
ACTION:[ ]
C ]
C.F.# [ ] ORD.# [ ] FILE COMPLETE="X" [ ]
� � � � � s � � � � � �
FILE INFO: [RESOLUTION/CHECKLIST/APPLICATION ]
[ ]
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