96-138I --�nt ! n.F( `t ` / '
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Council File � S�-/3�'
Ordinance #
Green Sheet $ ✓ �
RESOLUTION
AINT PAUL, MINNESOTA
Presented By
Referred To
Committee: Date
`l`�'
1 RESOLVED: That application (ID #64780) for a Parking Lot/Ramp License applied for by
2 AGC, Inc. DBA N A Parking (Nancy Adamek, President) at 100 Sibley Street be
3 and the same is hereby approved.
�� N�„�„� n�„+ � Requested by Department of:
Adopted by Council:
By:
App�
By:
Office of License. inspections and
Environmental Protection
BY: ��:�...e, ,�,��
Form Approved by City Attorney
/ �`
/� i
By: �'i/��v..w��... J� ✓��
Approved by Mayor for Submission to
Council
By:
Adoption Certified by Council Secretary
9G - �38'
OEPARTMENT/OFFICFJCOUNCIL DATE�NITIATED GREEN SHEE NO 35263
LIEP/Licensin INITIAUDATE INITIAL/DATE
CONTACT PERSON & PHONE � DEPARTMENT DIRECTOR O CfiY COUNqL
Bill Gunther, 266-9132 ^u��" OCINATTORNEV �CITYCLERK
NUYBERFOP
MUST BE ON COUNCIL ACaENDA BY (D TE p011'�NG � BUDGEf DIREGTOfl � PIN. & MGT. SERVICES DIR.
� l � ORDEti � MqypR (Ofl ASSISTANT) �
For hearin : !O
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
ACiION REQUESTED:
AGC, INc. DBA N A Parking requests Council approval of its application for a Parking Lot/
Ramp License at 100 Sibley street (ID 4�64780).
RECOMMENDATIONS: Approve (A) or peject (R) PEHSONAL SERVICE CONTRAC75 MUST ANSWEFi TME FOLLOWING �UESTIONS:
_ PLANNING CAMMISSION _ CIVIL SERVICE CAMMISSION �� Has t11i5 perSOMirtn ever worked Under a conhaC[ for Mf5 dBpertmeM? -
_ q8 COMMffTEE _ YES NO
_ S7AFF 2. Hd5 this PErsoNfirm eVer been a Giry emplOyee?
— YES NO
_ oISTHICTCAUHT � 3. Does this persanMirm possess a skill not normall ssessed
y po by any curtent ciry employee?
SUPPORTS WHICH COUNCIL OBJECTIVE4 VES � NO
Ezplatn all yes answers on separate sheet and attaeh to green sheet
INITIATING PROBLEM, ISSUE. OPP611FTUNITY (Who, What, When, NTere, Why)
ADVANTAGESIFAPPROVED'
DISADVANTAGES IFAPPROVED'
DISAOVANTAGES IF NOTAPPROVED:
�Y�' i�:,.4'rw*R� 5+���M
S � [� ^
V: i�{� lN �I iU� `�.
TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIIiG SOURCE ACTIVITY NUMBEH
FINANCIAL INFORMATION: (E%PLAIN)
1 \
9G-�3�
Greensneet # 35263 L.I.E.P. REVIEW CHECKLIST
In Trackef?
Date: 1/10/96 / t /7 i /
App'n Received / App'n Processed
License ID # 64780 License Type: ParkinQ Lot/Ramp
Company Name: AGC Inc DBA: N A Parking
Business Addresss: 100 Sibley Street Business Phone: 645-8077
Contact Name/Address: Nancy Adamek, Pres. 1571 Stickney St Home Phone: 455-5879
South St. Paul, 55075
Date to Council Research:
Public Hearing Date: � - � -�
Notice Sent to Applicant: �v���//
,�2, �� �
Labels Ordered:� N ��'1
District Council #: � �� �
Notice Sent to Public: �il���U1 ��/� Ward #:
Department/ Date Inspections Comments
City Attorney t
l- /7- q6
Environmental
Health f ���,� 6 6�
M-� -
Fire /^ �/ �[�'
Z p L�
License t_ `� ,�� 6� sne aian aecet�ed:_
tease ae���ed:
Police 1 � �� — �,� d� �tfd �e� �Ufil.b
Zoning 6 �
1-��- �G
. . �—..
CLASS III
LICENSE APPLICATION
$�-i3 �y�s�6
CITY OF SAINT PAUL
Office of License, Inspections
and Envitonmen[al Protettion
350 5� Pc.c 5� Suim 3oJ
Szim Pau1. Y.innaou 55102
(612)366-9090 (i (6]?).66-9q4
THIS APPLICATIOA' IS SUBJECT TO REVIE�'I BY THE PUBLIC
PLEASE TY�E OR PRINT IN I\iK
Type of License(s) being zpplied for: �pen dl t' pdY'ki ng 1 ot
CompanyA'ame: AGC, Inc, dba N.A. Parking
Corporztion / Partnership / Sole Proprietorship
If business is incorporated, give date of incorporation: �Ctober, 1980
Doin�BusinessAs: N•A. Parking 645
Business Phone:
BusinessAddress: 1571 Stickney Street South St. Paul MN 55075
SVeet Address /o o S��Iey s-i- Ciry Sute
Zip
Between what cross streets is the business located? Wdrner Rodd at Si bl ey ��ch side of the street? n01^th
Are the premises now occupied? no What T}pe of Business� Pdl^ki ng 1 ot
MailToAddress: P•�• Box 18003 West St. Paul MN 55103
Sveet .Address Ciry Siate
Zip
Applicant Information:
Nancy L.
Name and Title:
Fleming Adamek President `�
� First Middle (Maiden) Last
TiUe
Home aaaress: 1571 Stickney Street South St. Paul MN 55075
���� Sveet Add ss City State Z9p
Date of Birth: Place of Birth: 455-5879
Home Phone:
Have you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES NO X
Date of arrest: Where�
Charge:
Conviction• Sentence:
List the names and residences of three persons of good moral character, livin� within the Twin Cities Metro Area, not related to the
applicant or financia]ly interested in the premises or business, u�ho may be referred to as to the app]icant's character:
NAME ADDRESS ' PHONE
List licenses which you currently hold, formerly held, or may have an interest in:
93 East Ninth Street
Have any of the above named licenses ever been revoked? _ YES X I�'O If yes, ]ist the dates and reasons for revocation:
Are you going to operate this business penonally? X YES _ NO If not, who will operate it?
_ Will be operated by attendants under my supervision
fint Name Middle Imna1 (Ma�den) I,
- . Date of Birih
Address: Street 2.*ame
, , CnY State Zip PAone Number
Are you going to have a mana�er or assistant in this businzss?
please complete the follo�ving information:
Rnhart J.
�'i�-i3�- '
X YES _ NO If the manager is not the same
Fin[ 1�'arne Middle Initial (�1v3�n)
1571 Stickney Street South St. Paul
Date
Home Address: Stree[ Name
Cirv
Please list your emp]o}�nent history for the previous five (�) ; ear period:
Business/EmpIo��nent
N.A. Parking — 15 years
Las[
MN 55075
State Zip
Address
Phone
List all other officers of the corporation:
OFFICER TITLE HOME HOME BUSII�iESS DATE OF
NAME (Office He1d) ADDRESS PHONE PHONE BIRTH
none
If business is a partnership, please include the followin� information for each partner (use additional pa�es if necessary):
First Tarne
Home Address: Sveet A'ame
First h`ame
Home Address: Street Narne
Middle Initial
Middle Initial
(�izidzn)
Cirv
(!�fxiden)
Ciry
Lut
$iate
Lazt
State
Date of Birth
Zip Phone Xumber
Date of Birth
Zip Phone t�umber
MIN23ESOTA TAX IDENTIFICATION A'UMBER - 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 identification number and the social security number of each ]icense applicant.
Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are requ'ued to advise you of the
followin� re�ardin� the use of the Minnesota Tax Identification Number:
- This inforznation may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales,
employer's withholding or motor vehic]e excise taxes;
- Upon receivin� this information, the licensin� authority v.�ill supply it only to the Minnesota Deparhnent of Revenue.
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).
Social Security Number:
Minnesota Tax Identification Number. 5985062
Nancy's
_ If a Minnesota Tax Identification Number is not required for the business being opemted, indicate so by placing an"X" in
the box. �
r.:,.a -.k"s� "�,'-�,s;=�a. � �3'..; � - _ .
CATION OF WORKERS' COMPENSA710N lUVrKnun r�navr�.ivi P � �••��� •�>•
• � certify that I, or my company, am in compliance ��•ith the �vorkers' com ensation insurance coverage requirements of
'.''sota Statute 176.182, subdivision 2. I also understand that provision of false information in this certification constitutes sufficient
,nds for adverse action against all licenses held, includin� revocation and suspension of said ]icenses.
,ame of Insurance Company: Berkel ey Admi ni strators (WC) �li —�3�
, Coverage from 04/08/95 to 04/08/97
Po]icy I�umber: 0403717306
I have no employees covered under �i orkers' compensation insurance
ANY FALSIFICATION OF A1VS\�'ERS GIVEN OR MATERIAL SUBMITTED
WILL RESULT IN DEtiIAL OF THIS APPLICATION
I hereby state that I have answered all of the precedin� questions, and that the information contained herein is true and correct to the
best of my kno�+�led�e and belief. I hereby state further thzt I have received no money or other consideration, by way of loan, �ift,
contribution, or othenvise, 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 o�cials at any and all times when the business is in operation.
O1/04l06
Signature (REQUIRED for all applications) � Date
**I�TOte: If this application is FoocllLiquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), 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 chan�es to the pazking lot, floor space, or for new operations, please contact a City of Saint Paul Zonin�
Inspector at 266-9008.
Additional application requirements, please attach:
A detailed description of the design, location and square 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 8 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 ail 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 expansion of the licensed facility, indicate both the current area and the proposed
expansion.
A copy of your lease agreement or pioof of ownership of the property.
FOR SPECIFIC APPLICATION REQUIREMENTS, PLEASE SEE REVERSE >>>>
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