87-1736 .�MITE - CITV LERK
PINK - FINA C�E COVnCII y/��. l/ -yf
� CANARV - OECA TMEN7 GITY OF SAI T PAUL n 7 IIV � �
BLUE - MAV File NO• " •
. f � ou 'l olution .�:�. ~
,
Presented B >
Ref rred To Committee: Date
Ou of Committee By Date
RES VED: That Application (I.D.#14242) or a Physical Culture Health Service
Club License at 781 Pelham Bou evard applied for by Constance Bos
DBA Delores' Whirlpool be and he same is hereby approved.
C UNCILMEN Requested by Department of:
Yeas Nays �
N cosia
R ttman in Favor
S heibel �
S nnen Against BY
[r7 ida
W 180n DEC —3 �7 Form pproved y i A orney
Adopted by Council: Date
Certifie P•s by Co ncil S ry BY
By
A�pprov 1Vlavor: Date Approved by Mayor for Submission to Council
By BY
.
. � . ���73�h �
� � N° 011328 �
� DEPARTMENT �
CONTACT NA1dE •
� - S lo PHONE �
� DATE
ASS G N OR (See reverse side.)
_ De �tment Director Mayor (or Assistant)
_ Fi ance, and 1�Iariag�ment Services Director 3 Citiy Clerk
Bu get Director � ' � ('���Q.�, ..�h-c-g
� Ci Attorney _
T (Clip a 1 locations for signature.)
W ING C ? (Purpose/Rationale)
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OST T BUDG Y ND P RSONNEL C
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F NAN II G ACTIVITY GED OR C
(l�iayo 's signature not required if undez $10, 00.)
Tot 1 Amount of Transgction: �.�� Activity Number: 1� ((�
Fun ing Source: 1/� I.�
ATTA NTS: (List and number all attachmen s.)
,�
. C� �
� ,�G �-�/�. �
D TIVE OC 1"� �,(,�
es _No Rules, Regulations, Proced res, or Budget Amendment required?
es _No If yes, are �they or timeta le attached?
EP N RE CITY ATTORNEY REVIEW
� s _No Council resolution required? Resolutian required? ✓ Yes _No
_ s +� Na Insurance required? Insurance sufficient� _Yes _No
es ✓No Insurance attached? • '
��7 l 7.� �
DIVIS ON OF LICENSE AND PERMIT ADMINISTRATION DATE C-Z . l c� ( ( � f R`7
INTE EPARTMENTAL REVIEW CHECRLIST �-�� \��� .
Appli ant �,(�tAStu.h' 9 Y 1 .� �. Z`�.�. � Ic_.. � � ZOL
P �-,S e Address ,Z , C � r,�,,.,,,
� Yl -S t_- t cc�SZ. o°� �
Busin ss Name��prP� �In.,�.(�jva� H e Phone `j 'i i --C7�`7�
Busin ss Address 1�� ���'1� ���,rQ.�� pe of License(s)� . �z„�..��Q
�
Busin ss Phone `�,�� _ ���� -�,�
Publi Hearing Date ' ��� L cense I.D. � 1���a
at 10 00 a.m. in the c �� �'�'-
3rd F oor Citq Hall and Courthouse S ate Tax Z.D. � b�a LP
�
- � -a� - 3�I- - c�-E- °2 � �� ! 5
REVI DATE DATE NSPECTION
APPN REC'D VERFIE COMPUTER CO1rIl�tENTS
Not
Housi g & Bldg �
Code nforcement i0 �
�1 � � � �c> i
Publi Health I
G � � � �
�
i
Fire revention 4
� l,� � 12� � o �
�
Polic � I, � ��a �
�P �
n.R-c rd2..
City torneq �
lo ` t
� i
ENS ��)� �
� � �3 �
300 F t Notice �U I
/ � i
I
Licen Inspector's Comments:
I HA BEEN GIVEN A COPY OF TIiIS NOTIFICATION UNDERSTAND THAT MY ATTENDANCE AT
THE P LIC HEARING IS REQUIRID.
.�I�.�� ��- C� 1 � 3 ��
�
\
CURRENT INFORMATION NEW INFORMATION
Current Corporation Name: New Corporation Name:
Curreat DBA: New DBA:
Current Officers: Insurance:
Bond:
New Officers:
Stockholders:
�
. . . , . .
. , ��7�%��✓
CITY OF S . PAUL
DEPAR'17M9iT aF' FIl�1AftCE MARAGS�PP SSRVICLS
LICENSE ARD DIV�SIOA
Thes statement forms are issued in d�glica . Please ansWer all qnestioas ful�y aad
comp etely. This application is thorough�y hecked. Any falsification vill be cavse
tor enial.
Dste — 19
1. licatioa for q � e�(Liw�) (Permit)
2. o! applicant .��� � �j
3. applicnnt is/has been a married Pemale, list maiden name
�+. te of birth ,,j— /�, � �� Age� lace ot birth t�"]L, h''(,,f,/� /
5. you a citizen ot the United States Nstiv�e _ l�aturalized _
6. yau a registered voter < re ��. ��/ , G"�_,�/i�/
7. saaresa y _ �� r� � , �' �'2 Aome telephane 7���'7.�
a. � sent bus�ness aaareas /, � � _��', Bus�ness ��� -� � - 96 q�
9. I luding your present business/empl , , v5at bnsiness/eaplvymeat bs�+e ycn
f loWed for the past five yeara.
Busineas/F�ployment Address
, •r / , � ,
I C � f„�.`�r.. �) U/. 7f1, ��' �4Ccy►87—.`.�=
J � /�� � ,� , �`—
�
,� , / ��x /9�7
10. ied /� IP anaver is ';ves", liat name and addresa ot apause
11. ?ia you ever been arrested Por an otlenae that has resulted in a coQVictionY /`?U
I� ns�er is "yes", list dates ef arrests, re, chargea, comictions and
ae ences.
Dat o! arrest 19 1�lhere
.GE
� �N SII4TIIPCE
Dat �£ arrest 19 where
CF�A Gr
CO ICTIOiJ S�•gp�
. . �-��f���
. . � i/
'12. List the names and addresses (if marri , name o! spouse also) of all persans
�
corporations, partnerships, associatio or organiZations Wi�ich in aay way have:
a. A mortgage interest in the 13censed premise, �
b. A security interest in tbe licensed premises, lictnse, or l�rnishings or the
licensed premise,
c. A pramissory note Por Punds loaned r the aperatio�n ot the licensed premise
or the purchase of"the license,
. Financially contributed to the purch e of the premise or the license it-
self
. Ar�y other interest either direct or ndinct, either Pinancial or otherrrise
i
in the licensed premise or the licen e itself, ��
� ft� �
Attac a copy hento of aay aad all documenta reterred to in this attidavit.
13. ive namea and addreases oP tvo peraons, esideats of St. Pavl, Minaesota, aho
an give information concerning you.
1QAl� ADDRFSS
I j�ln � ��-� S-f-. S�. �a,�
� �- y��y
14. dreas of premises for Which License or ermit is made
�
dresa 7 Zone clasaificationl,ahf ,�I'►p�/,c�f�d
n�- �t,r•.d �—
15. tveen What croas atreets e0/Y1G/` v� h. � Which side oP street_�f,�/
16. under vhich thia business rrill be co ucted 7 � � % r 1 � �
17. siness Lelephvr�e number � - 7 �
1Q. A tach to this application, a detailed de cription of the design, location, and
s uare Pootage of the prtmises to be lice sed
:.9. a. e oremises no�r occupied �What bu iness Ho� long
, � . ��=�7—i73�q.
�/
20. List licen �ich yau ,, ent y hold, o f �y he,l , or may have an intere
in /
a � �' �-
21. Have auy of the licenses listed by you i No. 20 ever been revoked. Yes
a _�. If ansxer is "yes", list dat s aad reasona:
22. you hsve an interest of ac�r type in a ot.ber busineas or business premises. /�/`�
' answer is "yes", list business, busine s address aad telephone number.
23. f business is incorporated, give date of incorporation 1'�.b 19
nd attach copy of Articles of Incarporat on and ffirnrtes of first meeting
2�. st all ofPicers of the corporation givi their names, oftice held, hame
dress, and home and business tel�phone umbers:
. 25. I business is partnership, list partner(s a.ddress an� telephvae a�bera;
� r st.��
N �D � (9'(`'�C t�,.� Address j�(/ ��Cc.��� J� 'I1el.Ao. � �.,3 -��I:�yr
_
� 11� � : 3 a� No . ,N. �Ide�.ua.tl� 5"a9-c��.L
�� . . sfi. - � �t S
26. Ia there a�yone e se w o ,�I ave an iute ; s n ��� �ss or premisesY
Ir ansWer is "yes", give nsiae, hame address, telepho�e nv�bers and in rrbat
r is tbeir interest:
27. A you goir►�r to operate this business pera nal]y �S i! not, who xill operste
�t �
N Hame dress Te1.Ao.
, ` � �-��-���!�
��
Are you going to have a !�iana�;er vr assi tant in this business? IP answer is
"yes", give name and ho:ae address and h teleghone riumber: �O
Name H address Te1.No.
29• Has arLyone yau have named in questions 22 throu�h 25 ever been arrested? IP
answer is "yes", list name of person, d es of arrest, where, cha.�ges, com�ic-
tions and sentence
30. I understand this premise ms�y be in-
spected the police, fire, healt a.nd ther city oPficials at a�r and alI
imes rrhen the bnsiness is in operation.
State of yiinnesota) �
)SS
Coun of Ramsey )
�,
� � `��� being Yirs du�y sworn,. deposes and says upon
oath. hat he has rea.d the foregoing �tatement aring his signature and lmor�rs the
co�ate s thereof, and that the same is true of his own l�or�ledge except as to..those
ma.tte therein stated upon information and be ieP and as to those matters he be-
lieve them to be true. .
Subsc bed and svorn to bePoze me
Signature oP Applicant
this /fd�� day of 1?�
0
/
. Notary Public, i3amsey Co ty, innesot '
RQLfING
� C SS�OII C7CpI R�-E�N �'� NNE50��` , �
NOtAa 1989
MsEr�N�r
,� RA SeP�•22.
ires
MY �ommissio�exp
------- ------------------------ AGENDA ITEMS = ----------- -- ��7����
---�-----l-------------- ------------------------------
. {
ID#: [3 4 ] DATE REC: [10/14/87] AGENDA ATE: [00/00/00] ITEM #: [ ]
SUBJECT [PHYSICAL CULTURE HEALTH SERVICE LIC.- DELORES' WHIRLPOOL-781 PELHAM]
STAFF SIGNED: [NONE ] SIG:[ �� 7 OUT-C ] TO CLERK {-AAf�6f88] �4��5`
CIRIGIN OR:[LICENSE DIV. ] CO ACT:[SCHWEINLER - 5056 ]
ACTION [ ]
C 7
C.F.# ] ORD.# [ ] FILE COMPLETE="X" [ ]
� �e � s +� � � � � � �
FILE I F0: [RESOLUTION/CHECKLIST/APPLICATION ]
C J
[ J
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"'�' � �!�. L14242
Dear Pr erty Owner: '
Application for a Phy ical Cultural_�Health Service Club
�� -PO�E License
�� ����� Constance M. Bos DBA elores' Whirlpool
I
�'�C � 'rc� 781 Pelham Boulevard I
f
T November 10, 1987 � 9:00 a.�.
ti �I yC Cit��Council ChamD rs, 3rd ::1oor Cit� :aii - Cour� c�ousz
3y License and Pe 't Division, Department o= cinance ar_d
T �' T" ^' wanaaement Service �oom 203 Cit 3a11 - Court :ouse
��`�! ��. S��l ' ' � � (
Saint ?aul, u.innes ta
-298-�050
Th s date may be chan�ed without t e consent and/or �newled�e oL t�e
Li ense and Per,nit Division. It : su�gested that �ou ca11 c�e C�t;r
CI. r:c' s Of zice at 298-4231 �z you r ish confi�at;on.