95-354ORIGINAL
Covncil File # �� J �
Ordinance #
Green Sheet # 30765
Presented Hy
Referred To
RESOLUTION
AIN� PAUL, MINNESOTA t��
Committee: Date
1 RESOLVED: That application ii•D. #65095) for a Dance Hall License applied for by Hmong
2 National Development Inc. (Vue Long, Member) at 600 Cedar Street be and the
3 same is hereby approved.
�'---��—��---� Requested by Department of:
�
Approved by Mayo� Date
Office of License, Znsoections and
Environmental Protection
L' � �,,✓ ' / .�%
Form Approved by City Attorney
8,,: 1� • l� � � - /G - �5
Approved by Mayor for Submission to
Council
By: VgWIN e w
By:
Adoption Certified by Council Secretary
g� _.���
OEPAflTMENT/pFFICEMqUNCIL DATE I TIAT N� 3 0 7 6 5
LIEP/Licensing 3 y°l� GREEN SHEE __ -_ Nrt ��
CON'TACf PERSON & PHONE � OEPARTMENT DIRECTOH � CffY COUNdL
Bill Gunther/266-9132 �w �cmanomuev �cma.ECm
NUYBER FOR
MUST BE ON GOUNCIL AGENOp BY {OqTE) q��� O flUOGET OtRECTOR � FIN. 8 MGT. SERYICES OtR.
r'Or Hearing: S �" � �MAVOP(ORASSISfANT) O
TOTAL # OF $IGNATURE pAGES � � �(CLIP ALL LOCATIONS FOR SIGNATUR�
ACf10N qEQUESTED:
Hmong National Development Inc. requests Council approval of its application for a Dance
Hall License at 600 Cedar Street (I.D. I�65095).
qECOMMENDATIONS: Approve (A) or Rejett (R) pERSONAL SERVICE CONTHACTS MUST ANSWER TNE FOLLOWING QUESTIONS:
_ PLANNINCa COMMISSION _ CML SERVICE COMMISSION 1. Has this personlfirm ever worketl untler a CoMract for this department?
_ _ CIB COMMITTEE _ YES NO
_ STAFF 2• Has this Personttirm ever been a ciry empluyee?
— YES NO
_ DISTR�CTCqUR7 _ 3. Does this person/firm pos5ess a sKill not normall ossessetl
y p by any curtent city employeel
SUPPOFTSWHICHCOUNCILOBJECfIVE? YES NO
F�cplatn all yea aaswers on aepa�ate sheet and attech to greeo ahees-
INITIATINC+PqOBLEM. ISSUE.OPPORNPIITY (`Ntro. WFat, When, WhOre, Why):
C t�8�.�3m� 9ti'���"�i�
i't ;'=:s'Y '' �� ����
ADVANTA6ES iF APPROVED:
DISAOYANTAGES IF APPROVED:
DISADVANTA6ES IF NOTAPPRO�E�.
TOTAL AMOUNT OF TPANSACTION $ COSTfREVENUE eUDGETED (CIRCLE ONE) YES NO
FUNDING �SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
30765 9� 3s�
Greensneet # L.I.E.P. REVIEIN CHECKLIST Date: 3/9/95 �
In Trackeh app�n aeceived / npp'n Processed
License ID # 65095
License Type: Dance Hall
Company Name: �ong National Development Inc. pSA: Same
Business Addresss: 600 Cedar Street Business Phone: 558-5800
Cornact Name/Address: Vue Long Home Phone: 487-7950
Date to Gouncil Research:
Pubiic Hearing Date: � °�� -��
Notice Sent to Appiicant:
Notice Sent to
Labefs Ordered: �,��f
District Council
Ward
02
Departmentf Date Inspections Comments
City Attorney
��I6 ^�
Environmentai
Health
Fire
License s � 5'�� Site Plan Received:
3 �e� ��,�ed:
Police
Zoning � e �� � � �/
. ' ;' ��.
CLASS III
LICENSE APPLICATION
CITY OF SAINT PAUL
O;um of Littr.sq Inspections
and Er,�ironnental Proicaion
i5G Sc PC.¢ 5� Swte 3�0
�.:_.�,w.+t;�o:, ss�c�
(6!]) 2YA7'JO '. t672) ]LbAI]A
Licebse I.D. ;� ��J'S � � �
(ror ofrcc use only)
THIS APPLICATION IS Sti3SECT TO REVIE�'J BY THE PUBLIC
PLF�ASE TYFE OR PRI2�'T IN L\'K
Type of Licease being applied f l.lS �!�1 V ���ft t 1 l yu'� V 1✓'T `1-� rn✓k \�ti�. Y�t� �`'FC
Company2�ame:'�LNC-�1VA°�ilN�n-� �2,la4JV+�En7�C� � �N��
�
Corporztion / Partnenhip f Sole Proprietoa�ip ' ,
If business, is incorporated, girve date of incorporation: .
Doing Business As:
Business Address:
Stree[ Address
Bet�een w•hat aoss streets is tbe basiness located?
Are the premises now occupied?
Mail To Address: "l �
What T}pe of
�Plz� 1T=`i KCYJ
Z;p
Which sida of tl�e street?
S;reet Address City ' State Zip
Applicant Informztion: , )
I�'ame and Title: �—LS �J G V wG �VYZC
� Flst Middlc ('.faideal � Lzst Tivte
Home Address:
Street Address
Date of B'uth: � - Z g (o �
�(
Gty S;ate Zip
Place of B'uch: � a� S Home Phoae:�� / Z� �-�'7 ��'i St:
Are you a citizen of tl�e United States? Native? Naturalized? �
If you are not a U.S. citizen, you must have work authorization from the US. Immigration & Naturalization Sec-Fice.
Have you ever been con�icted of any felony, crime or �iolaaon of any city ordinance other than Ir�c? YES _ NO �j
Date of arrest:
Chazge: �
Con��iction:
R'bere?
9� 3s�
� v.� Business Pbone:�
��vt�n �A- f�7 �
City S:2te
�Sentence:
List the names and zesidences of three persons of good moral cbazacter, living within the TWin Cities Metro Area, not related
to tbe applicant or financially interested in the premises or business, who may be referred to as to tbe applicanPs character:
NAI�4E
ADDRESS
PHONE
Z
Have any of the above named licenses ever been revoked?,,_YES �I�CS. Tf yes, list the dates and zeasons fot revocation:
riea�s�
List licenses which you currently hold, formerly held, or may have an interest in:
.�re you going to operat �this business personaiIy? _ 1�S � NO If
v'V�c�v�o,r- (�) W-���ltirti� � �"'����� c/
Fust A Diiddle Initial (`.Sai3en)
who will operateit?
I<SL
.� '� �
Dzu of Binh
taZ]S��- S&X:
HomeAddxx� S;:eetNane v C:y St;te Zip 'Yhonefiumbet
Are you going to have-a manager or azsutant in this bu<_iaess? � YES _ NO If the manager is not the same as the
operator, please complete tl�e following information:
fiist Nzme Middle Tnitiat
(?.C.i3en)
Home Address: S:ut Name G:y
Please list your empIoyment history £or t6e pre�ious fi��e (�� yezr period:
I,ast
Statc Zip
Address _
Date of Birth
Pfione \umbet
�n SSioa
i�1�3C�
�4`1 11
List all oiber officers of the corporation:
OFFICER TTTLE HOrLE HO?�iE BUSL\'ESS DATE OF
NA�N ( ce Held) AD PHOI�� " PHO�'E `- BIRTH
iC' �Co1.a..a. � h&-L esekFA�e �/4'�i.v�e�a� E�! �40[�7�1 4o�f<"T�'X7''� ��F"TD
�� �-� �i ���. � i� t+� v ���1 �w 9x� a t3az��5s� `�� S7
C��v+�vi 1-� ��rxc= � W ��P�I �vr� ti /C�t L>�'7l -44 to
If busine�ss is a p2rtnership, please indude tbe followiag i,.foraavon for each partner (use additioaal pages if necessary):
\ame
Middlc Initial
(1:ziLen)
Lzsi
Date of Binb
Pfione Number
Bate of Birth
Home Addres� Street 1`ame
Fixst Nane
Middlc Ini[ial
6iy
(:J.aiden)
Stata tip
Last
Hone Address: $trect \ame Gry State Zip Phonc ?�umbet
Atfach to this application: '
i) A detailed description of the design, location and square footage of tLe premises to be licensed (site plan).
2) A copy of your lease agreement or proof ot owversLip of tf�e property.
AA'Y FALSIFICATION OF A2�SFTr'ERS GIVEI�I OR MATE1tIAL SUBD4ITrED
VVILL 1ZESUI,T II�I DE\L4L OF THIS APPLICATION
I bereby staYe under oath tl�aY I have answered all of tbe above quesfions, and that ttre information contained berein is true and
correc[ To ihe best of my knou9edge and belief. I Lereby state furtber oa I bave reccived no money or other
consideration, by way of ]oaa, gift, conin'bution, or otherv.�ise, other eady discJosed ' the application which I berewith
submitted. �
1
Subsrn'bed and swom to before me this
� rc1 day of ��rch . 19q^ � cant ate
�Q.s.�;n a 2. �„�.� � � .; MARINA . MPOS
Notary PubIic Dakc4c- umy MId � •^O ^'�""���
' • � MY WMMI ON EXPIRES
My Commissioa exp'ues: �- 3 i 2cc6 9 .,,,ad� JANUARY 31, 20D0
9�S-3-s�
PLEASE NOTE - FAILIIRE TO SIIPPLY THE FOLLOAING INFORMATION AILL
JEOPARA22E OR DELAY THE PROCEBSZNG OF YOIIR LSCENSE ISSIIANCE OR
RENEWAL APPLZCATION.
MINNESOTA TAX IDENTIFICATION NIIMBER
Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8,
Section 2(270.72)(Tax Clearance; Issuance of Licenses),
licensing authorities are required to provide to the State of
Minnesota Commissioner of Revenue, the Minnesota business tax
identification number and the social security number o£ each
license applicant.
Under the Minnesota Government Data Practices Act and the Federal
Privacy Act of 1974, we are reguired to advise you of the
following regarding the use of this information:
1) This information may be used to deny the issuance
or renewal of your license in the event you owe
Minnesota sales, employer's withholding or motor
vehicle excise taxes;
2) Upon receiving this information, the licensing
authority will supply it only to the Minnesota
Department of Revenue. However, under the Federal
Exchange of Information Agreement, the Department
of Revenue may supply this information to the
Internal Revenue Service.
Minnesota Tax Identification Numbers (Sales & Use Tax Number) may
be obtained from the State of Minnesota - Business Records
Department - 10 River Park Plaza. Phone: 296-6181.
Applicant�s Last Name First Name Middle
SSI � � 4f�?-795'v
s
, ���..�,
2 - 8"Z� '- 3 l � ''-_Wi ��b� ��-
nt's Social Security # Position (Officer, Partner, etc.
�
` -� - l� - foF�l3� �mz g- �
Business Addr s ity, State, Zip Code Phone No.
Minnesota Tax Identification Number: �
(If a Minnesota Tax Identification Number is not required for the
business being ope , in ' te so by placing an "X" in the
box.)
` � .1RR5
\ i ature Date
� ,
.• •. ` LERTIFICAiIGN OF C04PLIAFCE VIiN 7HE M1NkE50iA 17DRKERS' COMPEFSATIOH lA4 �� - 3 S�
4 Reeording to HH Statutes 176.782, licensing agerxies �re prohibitcd frem issuing lieenses ui:hout verification of workers` toan,
cove�age. A i10Eli5E APPLiUTSCM UN1iOT BE PROCESSEU NtLESS THIS FQRN IS COltF'IETED SIGHED AND RETl7R77N (please pf�nt). A�y
questions on tilling out ihis form shoutd be direc.ed io the Siaie of xinnesota "Special [or,Qensation Fund" - 296-2177.
1 ' n`� �: `�� 1 �
Hane �tl C= � C]rl v Doing busincss as ` aYS✓� ✓� � ¢ J �^✓ '�t
— �st tirst riddte fuLl busin•ss nor,+c, if d�tferent 2 n your n ne
SoGial Sccurity ho. �� q Z' ��0 Z- Fedcral Er,pLoyer ID No. — State ID No, —
Address �� �kio c4U'G ��'� � ` - ���. � ` 1'Yl � �( e�
. streei ndiress or roufe n,rber city ot' town rame sTate na:oe aip code�
Business 7elephone No. ( [cl t ) ZZ-�-{ b� Hone ietephone k;o. (�2-3 `Y��� 7�t �
Type ot Business �'✓� C +Z � �� � �YCX24-N � /�'�'�-�'�-�
description for exar.Qt : bu�l�9 consiruction; or toggtng, or nanufac�un n5)
17orkers� Camensaiion
tnsurance Ca;pany Na,�ne Policy No.
full name of insurance cor,pany (xoT inwrance a°eni> full n�cr 4ran insurance policy
Daies of Coveragc ihrougi
stariing date endirg datc
- OR-
I certify that I mm �ot required to carry uorkers' cor,Qensation insurance because:
Uheck One)
I am a sole p�oprictor ar� f have no r.rQloyecs.
�I havc no cr•Qloyccs vho arc covered by thc uorkcrs' conpcnsatioo la++. (Only crtployces uho nre specitienfly exempted by
-- statut¢ are not covered by the uorkers' cortQensa2ion tnw. These i'xttde: Spouse; Parents; Lhjldren, fegardless of age;
and farm (abor crtQloyecs of a femily farm that spent lc'ss than 18,000 for farm labor in the previous wlendar ycar. All
oiher uorkers whose uork activity is controllab e"errQi.¢yer rtust be covered.)
I understand that ihe informafion pravided
understand that I am subject io a 21,006�per
is accurate erd c«iptctc. � ��
[NO loeal li[CnSing agCncy, gen. contr., ti
to che Dept. of Labor and Industry shali be
ve ❑' l �''vcrificd by t e Hinnesota Depariment of Labor and indusiry. i
, if nformation is f se. 1 certity that the inforRation provided above
ate � /LL_ C1�� � 5 •
cr person/organization acting as an intcrmcdiary to det3vcr this form
i" le for acc�racy oF ihe information provided by the person Si9ning the lorm.)
� � . CE£iIF7CAiIGH CF CO!iPLiRACE 'JIiH THE XIFFESGTA wJR�ERS' CQNPEBSAi1OH LAV �� 3 S�
A[cofdin9 to NH Sta:utes 176.782, litcnsing agcncics arc prohibiicd fran issuing IicenSes ui:hout vcrification of uofkefs' Co:m�
Covefage. A UCEMSE APPUUTIW UMNOi SE PFOCESSED UWLESS THIS FORN IS C0�'LETED SiGUfU AAD RENRNN (please pf�nU. Any
questions on fitling out this form shovtd be direcied co the State of Hirnesoia "Special Cor,Qens Furd" - 296-2157.
Hanc �'l L � � C� _ Doing busincss as��-� f v�T��\�
ast firsi r�ddle futl twsin ss nax, if differenG i n your n5ne
State ID Ho. —
Social Security Ko. ���1Z-� �� Z Federal Erpioyer I �Ko. -' r- � .
�/�CI ( /� ��'� >� �5 �iA-� � �Y11� l� � C� �i
Address ��� �"r state na:oe zip code
s:reet oddress oi rouie n•.rbec ciiy or toun ���
Xcne Tetephone Ho_ C ��'L-1 ��� � � � -
Business Tetep'+one No. C�L) ��Z�
Type of Business — Y t a 1� - �
. .._._ _ e,..
on; or Iogging; of
vorkers� Camensation v Policy No.
Insurance Cor�zry Nanc - ',u(t n�nScr frm insurance poliry
futl name of insvrance ca�panY CuC� insurance agent)
Dates of Coveragc ihrougi, .
stariing date ending datc
- OR-
] ce�tify that I am not required to carry vorkers' corfxnsation insurance because: .
(Check One)
I em a solc proprictor and I hnvc no crptoyccs.
✓ I have no cr•ployecs who nre covered by the uorkers' conpensaiion lav. (Only ertQloyees uho are specifically exertQted by
� statute are noT co�cred by the uorkers' ca:QensaTion lau. 7hese isxlw'e: Spouse; Pacents; Lhjldren, Tegardless of age;
ard farm labor rnployecs of a familY farm thai spcnt lc"ss than 58,000 for farm labor in the previous calendar ycar. All
echer vorkers uhose uork aciivity is controllab e� rust be covered.)
1 vrderstasd thaY ihe infornation providcd
undcrstand ihat I am subjcci to a St,000�per
is accuratc ard cmQtetc. � �
i
[No local licensing ogency, gen. contr.� ii
io She Dcpt. of labor und Ir��stry sha(I bc
w•' � 'verificd by t e Xinnesota Department of Labor and industry. 1
if' nform�tion is f se. 1 ceriiSy that che in4orrc�tion provided above
ate lYLC�� �� �
� cr person/organization aeting as an inicrmediary to dclivcr this form
' le for accuracy of che information provided by the person signing the torm.3