96-134Q����6'vr��
council File # �lo — �
Ordinance �
creen Sheet $ -�����
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
tts7
1
2
3
1
RESOLVED; That application (ID #13969) for an Off Sale Malt License applied for by
Mukund S.Toshi DBA Lou's Food Market (Bhaskar S Joshi, Owner) at 1199 White
Bear Avenue North be and the same is hereby approved.
�i __ _, , Requested by Department of:
Adopted by Council: Date
Adoption Certified by Council Secretary
By:
App
By:
Office of License, Insoections and
Environmental Protection
By: �'�-�`�'�C � �. i�
Form Approved by City Attorney
BY= �� 4i wi,r � ��i,.r�t
Approved by Mayor for Submission to
Council
By:
LIEP
For hearinQ: �'I � ` �E �
TOTAL # OF SIGNATURE PAGES
9G-i.jy
GREEN SHEET N° 35258
INrt1AVDATE INITIAVDATE �
� DEPARTMENTDIflECTOF � CRYCAUNCIL
O C(SY ATTOFNEY � CRY CLERK
� BUDGET DIRECTOR � FIN. & MGT. SERVICES �Ifl.
O MAYOR (OR ASSISTAN'n ❑
(CLIP ALL LOCATIONS FOR SIGNATURE1
. ..�.. � �� - --
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— Muknn� S IISA Lou's FooB t4arkef reqnests Conncil appioval of its application for an
Off Sale Malt License at 1199 White Bear Avenue North (ID �/13969).
PLANNING CAMMISSION _ qVIL SERVICE COMMISSION
CIB COMMITfEE _
STAFF _
DISTflICTCqURT _
OflTS WHICH COUNpL OBJECiIVE?
ISSUE.OPPEIRTUNITY(Who. What, When, Where,
IF APPROVED:
PEASONAL SENVICE CONTHACSS MUST ANSWER THE FOLLOWING �UESTIONS:
7. Has this personlfirm ever worked under a coMract for Mis department? -
YES NO
2. Has this personffirm ever been a city employee?
YES NO
3. Does this personrtirm possess a skill not normally possessed by any curtent ciry emplqree?
YES NO
Expletn all yes answers on seperate sheet and attach to green sheet
�e�'c� ��'� $t'��
.�, ,. u _ . , _,
TOiALAMOUNT OFTRANSACTION S
COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDINCa SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION: (EXPIAIN)
9 G_is�
Greensheet� 35258 L.I.E.P. REVIEW CHECKLIST Date: 12/28/95 /
In TraCket? P.pp'n Received / App'n Processed
License ID # 13969 LicenseType:�Jff Sa7e Malt
Company Name: Mukund S Joshi DBA: ro„'G Fnod Markat
Business Addresss: ll99 White Bear Avenue I3orth Business Phone: 7�6-��7R
-
ContactName/Rddress:Mnknnd Joshi Owner 4113 Monroe NE HomePhone: �St-�87t
Date to Council ResearCh: Columbia Hts, MN 55421
Public Hearing Date: - � y Labels Ordered: %����
Notice Sent to Applicant:_ � District Council #: ��
2� �
/.�i v�-�.
Notice Sent to Public: ' c.� � Ward #: �
Department/ Date Inspections Comments
Ci1y Attorney
�-S� 96 6�
Environmental
Health
J-S-2G o�K
Fire �� T'�Ol/�1�� ��/'�-Ol�l�L,
1- l6 - g�6
a � ��- 6 e�r� _
Lic8nS2 Site Plan Received:
1 _�- _ q t a � �e� r����ad: —
6 ��
Police
�-��Y� ��
Zonfng /
L � ��� �
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CLASS III
LICENSE APPLICATION
9G-i3�
THIS APPLICATIO\' IS SUBJECT TO REVIEW BY THE PliBLIC
PLEASE TY"PE OR PRINT IN I;�K
Type of License(s) bein� applied for: � C�7Z
Company I�'ame: M4f,�.�%��d S ., Q S��
Corporation / Parmership / Soie Proprietorship
If business is incorporated, �ive date of incorporation: L-�Cf Fc�o�e--�'+�f 1
Doin� Business As: ��V � S �-.� o d N14r�2K<= 1 Business Phone:
Business Address: 11 q4 k%��t"e ��� � S 1 �� ��i SS� O�
Sveet Address Ciry State Zip
Beh�een ���hat cross streets is the business located? 4;1�t�'e b�.ti t1V � MA^"��a Which side of the street? ���i
Are the premiczs now occupied? �?n What T}pz of Business? p �v� ��wl �F- �� �� �<<-O
Mail To Address: il �� W4 �� �-� � SY 1 a� 1-'`N S S\ � 6
Svezc Address Cin� State Zip
Applicant Information:
� 3 `\, -, W �.�
Name and Title: µVk��� S• Q S"� �' K ' t '� -
First Middle (Maider.) , Lazt Title
Home Address:
SVeet AddreSs
� �
cn .
CITY OF SAINT PAUL
O��e �f Licen�e, Inspections
and Em•ironmental Protection
350 Sc PnQ A. Sui:e 300
SaimPavl,�finnaou Sy01
� (61])'_66-9090 ta� (EL) ]6691]<
State Zip
Date of Birth: C� - O 3 5 � Place of Birth: ��� �1 '�� �� 0 . Home Phone: 7`� �-� �, �
Have you ever been convicted of any felony, crime or violation of any city ordinance other than tra�c? YES _ NO
Date of arrest:
Charge: _
Conviction:
Sentence: � � �
List the names and residences of three persons of �ood moral character, livin� within the Tv,�in Cities Metro Area, not re]ated to the
applicant or financially interested in the premises or business, who may be referred to as to the applicant's character:
NAME ADDRESS PHONE
,SO St S 1�i����.`i3 Si��1 72i-35Sb
as�t1 365 3� �i i'.N.+��o,�,�cs SS�118 `78�-�'
��l`�.�cn,os 43\ 6�R�- 1JC �n.u.��e��v�A� SS�i\'3 ''�lR- `�1vB�
List licenses v.�hich you currently hold, formerly held, or may have an interest in:
Have any of the above named licenses ever been revoked? _ YES _�� If yes, ]ist the dates and reasons for revocation:
Are you going to operate this business personally? _ YES NO not, who will operate it? �
3haskoti S :�cs�.i i
Fin[ Name Middle Initial (Maiden) LaSt Date of Binh
�zn'7 vJ �l� An�.v Mi.'�nheF�oo�.s �`�N SS �i Zt '7 � S 8 B I
Home Address: Stree[ Name
Where? � I �
State Zip Phone Number
Are you goin� to have a mana�er or assistant in this business? �ES _ NO If the manager is not the same as the operator,
please complete the follo�cing infom�ation: p� —/3 /
7 �jG
Fin[ �ame bliddle Inilial �?;zi3zn) ` LaSt Date of Binh v
{3�S�L 5 �O�KI —.._ [– Zb'�
Home Address: Sveet A'2me �� Cip� State
307 w 3�t`' c�- e"^�1:> �nv,
Please ]ist your employment history for the previous five (�) ; ear period:
Business/Emoloyment
2�w C
Zip Phone \umber
S�{2f 7Si^$4'cb
Address 1 � U ` \
1'�4C f�f �W,V�- t�`V �1 �Cehw � NS C� 7Vzv
W �lc,ck W�2� 3� �.��,..i �� QT 8 n i
List all other officers of the corporation:
OFFICER TITLE HOME HOME BUSIi�ESS DATE OF
NAME (Office Held) ADDRESS PHONE PHONE BIR7'H
If business is a partnership, please include the follo���ing information for each partner (use additional pages if necessary):
First Tame
A1idd7e Initial
Home Addre55: Sveet Name
FirSt t�'ame
Middle Initial
Home Address: Sveet 1.'arne
(\iziden)
Clh'
(912iden)
CiN
Last
State
Lasi
State
Date of Birch
Zip Pnone I�unbrr
Date of Binh
Zip Phone Number
MINNESOTA TAX IDENTIFICATION IQUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2
(270.72) (Tax Clearance; Issuance of Licenses), licensin� authorities are required to provide to the State of Minnesota Commissioner
of Revenue, the Minnesota business tax identifrcation number and the social security number of each license applicant.
ilnder the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the
following regarding the use of the Minnesota Tax Identification Number:
- This information may be used to deny the issuance or renewai of your license in the event you owe Minnesota sales,
employer's withholdin� or motor vehicle excise taxes; �
- Upon receiving this information, the ticensin� authority wiil supply it only to the Minnesota Department of Rever.ue.
However, under the Federal Exchange of Information A�reement, the Department of Revenue may supply this information
to the Intemal 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 (612-296-6181).
SocialSecurityNumber: ������' ��3q
Minnesota Tax Identification Number: a.377S� `�
D If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in
the box. " � �. �
� ` � � �, ,. : , ` _
�.era.,z�-uar;� �„^ ,#`ac
CEnIIFICAT]ON OF WORKERS' COMPENSATION CO\%ERAGE PURSUANT TO MINNESOTA STATUTE 176.182
I hereby certify that I, or my company, am in compliance �;ith the �vorkers' compensation insurance coverage cequirements of
j MinnesotaStatute176.182,subdivision2.Ialsounderstandttatprovisionoffalseinformationinthiscertificationconstitutes
? grounds for adverse action against al1 ]icenses he1d, includi,^.a re��ocation and suspension of said licenses.
Name of Insurance Company:
Policy Number:
Ce� zrage from
1 have no employees covered under workers' compensation insurance _ t��
to
A\Y FALSIFICATION OF AnS\['ERS GIVEN OR MATERIAL SUBMITTED
�VILL RESULT IN DE\IAL OF THIS APPLICATION
9� —�.3�
I hereby state that I have answered all of the preceding ques�ions, and that the information contained herein is true and correct to the
best of my knowled�e and belief. I hereby state further thzt I have received no money or other consideration, by way of ]oan, gifr,
contribution, or othen� ise, other than already disclosed in the application which I herewith submitted. I also understand this premise
may be inspected by police, fire, health and other city officizls zt any and all times �+�hen the business is in operation.
for all applications)
-�s•a5
Date
**A'ote: If this application is Food/I.iquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9li9), to
review plans.
If any substantial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply
for building permits.
If there are any changes to the parkin� lot, floor space, or for new operations, please contact a City of Saint Paul Zoning
Inspector at 266-9008.
Additional application requirements, please attach:
A detaifed description of ffie design, Vocation and 5quare footage of the premises to be licensed (site plan).
The following data should be on the site plan (preferably on an 8 1/2" x 11" or S 1/2" x 14" paper):
- Name, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N should be indicated toward the top.
- Placement of all pertinent features of the interior of the licensed faciliTy such as seating areas, kitchens, offices, repair
area, parking, rest rooms, etc.
- If a request is for an addition or espansion of the licensed facility, indicate both the current area and the proposed
eapansion.
_-_.-._:r` of
lease agreement or proof of o��nership of the property.
'PLICATION REQUIREMENTS, PLEA5E SEE REVERSE > > > >
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