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Council File �
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Green
RESOLUTION
CITY OF SAINT RAUL, MINNESOTA
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Presented By
Referred To
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Committee: Date
1 RESOLVED: That application (ID #49143) for an Off Sale Malt
2 Supermarket, Inc. DBA Minni Market (Pamela Su, Pr
3 Avenue East be and Che same is hereby approved. �
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applied for by Su
at 2019 Minnehaha
Adopted by Council: Date
Adoption Certified by Co}�
By:
Approved by Mayor:
By:
Secretary
Date
Requested by Department of:
Office of License, Insoections and
Environmental Protection
By: �./''.,_'�
Form Approved by City Attorney
By: �. �tr,r /l�zo-9�
Approved by Mayor for Submission to
Council
By:
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DEPAflTMENT/OFFICFJCAUNCII DATEINRIATED GREEN SHEE N� 35542
LIEP/Licensin INRIAVDATE � INITIALIDATE
CONTACT PEpS�N 8 PH�NE O DEPARTMEM DIRECTOR O CITY CAUNqL
ASSIGN CINATTOqNEY C17YCLERK
Bill. Gunther 266-9232 NUYBERFOP �
MUST BE ON COUNCIL AGENDA gV (DATE) �p�� O BUDGET DIRECTOR � O FlN. 8 MGi SERVICES Dlq.
� � � ONDEP � MAYOR (OR ASSISTANT) O
For hearin : ��
TOTA� # OF SIGNATURE PAGE (CLIP ALl LOCATIONS FOR SICaNATURE)
AC f10N REQUESTE
Su Supermarket, Inc. DBA Minni Market requests Council approval of its application for an
Off Sale Malt License at 2019 Minnehaha Avenue East (ID 1149193).
RECOMMENDAnoNS: Approve (A) or Reject (R) PERSONAL SEFiVICE CONTHACTS MUST ANSWER TXE FOLLOWING �UESTIONS:
_ P�ANNING COMMISSION _ CIVIL SEPVICE CAMM�SS�ON �� Has this person/Firtn ever worked under a contract for this tlepaltment? �
_CIBCOMMfI'TEE YES NO
2. Has this person/firm ever been a ctiry employee?
_ STAFF — YES NO
_ DISiRiCi COURi _ 3. Does this person/firm possess a skill not normail osseued
y p by any curtent ciry emplqree?
SUPPORTS WHICH CAUNCII OBJECTIVE? YES NO
Explain all yes answers on separate sheet and attech to green sheet
INITIATING PROBLEM, ISSUE, OPPORNNITY rNho, Wha4 When, Where, Why):
EdY3��5e6�Y4 4`p'„a..,,..,.? A''�t';E�'
SYAt�S fd w� dW�'��
ADVANTAGES IF APPROVED:
D1S4DVANTAGES IFAPPROVED
DISADVAMAGES IF NOTAPPROVED:
70TAL AMOUNT Oi TRANSACTION S COS7/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOUHCE ACTIVITV NUMBER
FINANCIAL INFORMATION. (EXPLAIN)
Greensneet # 35542 L.I.E.P. REVlEW CNECKLIST
In Tracker?
Comments
License ID # 49193 license Type: Off Sale Malt
Company N3me: Su Supermarket, Inc. DBA: Minni Market
— BusinessAddresss: 2019 Minnehaha Av E, ll9 Business Phone: 735-2246
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Contact Name/Address: Pamela Su, 3561 Cohansey St, Shorevi�me Phon�90�
Date to Council Research: 55126
Public Hearing Date: / - L ! -
Notice Sent to Applicant: j o
Labels Ordered: lI/17/95
District Council #: 2
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Notice Sent to Public: )� ��/�� ` � Ward
Department/
City Attorney
Environmental
Heaith
Fire
License
Police
Date
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Date: 11/2/95 / �'E' ��
App'n Heceived / App'n Processed
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Site Plan Received:_
Lease Received:
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CLASS III
LICENSE APPLICATION
CITY OF SAINT PAUL
Office ofLicense,Tnspecdons
ana Fn�vo,N,entaf rrotectian
�sa 5� r� sc s�»u 300
s.�ea,4 ��+ ssroz
(6t2) 266-9090 f�x (612) 2649124
THIS APPLICATION IS SUBJECT TO REV�W BY T�-Pi-z�L:C _________ __ _� �
PLEASE TYPE OR PRINT IN INK
T}pe of License being applied for: � Z I� 6"' D�� SA LE MA �--T .
CompanyName: Stl SUp�RP1ARKEr�C.
V Corporation / Parfiership 1 Sole Proprieto�ship
If business is incorponted, give date of incorpontion: CGY �� ( Q9.S
Doing Business As: M i NN ! MAi�K�7 Business Phone: ��Z' `T>
BusinessAadress: :�Ol9�N11Nf�EHAFIA �TPAUI... M�I �5!!9"3927
Street Address Ciry State Zip
Between what cross streeu is the business located? 6�Tw�EEN Ri:fN f�ND PETER S�N Which side of the street? i� C t2TH
Aret6epremisesnowoccupied? 1'�S WhatTypeofBusiness? SMAL4 fiROCER�
MaiiToAddress: 3561 CD'riA+ySE1' S7REF�i SND'(.FUIEW N}N 5.512&-"394�
S�eet Address Ciry Stam Zip
Applicant Tnformarion: //�
NameandTitle: f�/at'1E�-R SHU`MI1�Et s�1�N $�1 pRE�tD�NT
F'ust Affiddle (Maiden) Laat Title
HomeAddress: 356� COHANSE`( S}'REET 51i0(�Ci1iEW/ MrJ 55►26-390v
StrtM Address City State Zip
DateofBirth: i`RAIZ,S. lg�0 PlaceoFBirth: �1"AIWA�I HomePhone:6i2
Are you a citizen of the United States?I•�ONative? NaturaIized?
If you are not a U.S. citizen, you must have work authorization from the U.S. Immigration & Naturalization Service.
ReSideNTA��FN NIIMBER:�{029684$86
Have you ever been convicted of any fetony, crime or violation of any city ordinance other than traffic? YES _ NO �
Date of azrest:
Chazge: _
Canviction:
Where?
Sentence:
List the names and residences of three persons of good monl characier, living within the Twin Cities Metro Area, not zelated to the
applicant or fmancially intereszed in the gremises or business, who may be referred to as to the applicant's chazacter:
NAME ADDRESS PHONE
:7Atr'ET �F r91L�-�1� �DNARl�iET AVE 5HDR�Ul�bV Ml��5tZ6 6�2—IFB��C/�3�
�6e1�tA o150N 4oa CARD1�rAN StieREV��WMr1�5126 �rz—�s3-Yi3�
�}�t�oRA �3�fa CHANDi.�R sHD12�v�EW MtJ35t26 6rz—.�83-31�8
List licenses which you currenily hold, formerly held, or may have an interest in: � 0�j E
Have any oF the above named Gcenses ever been revoked? _ YES � NO If yes, Iisi the dates and reasons for revocation:
Are you going to opente this business personally? _ YES � NO If not, who will operate it?
�qW � c� T- ' SL! DEC, i 3, i94-6
Fust Name Middle Inifiat (Maiden) Latt Dnte of B'uth
356! Cor{qNSEr S'(R��.� SNo�z�V�EW Mr�1 5��26 612 49a5z��
Home Address: Stmt Nams
City
Zip P}�one Number
Are yon going to have a manager or assistant in this business? {'YES � NO IF the manager is not {6e�ame a�s'C[�opecato�r,
please complete the follawing informarion:
SAr9E qSTH� D�ci�Tat�
Fust Name hfdNe Iuitia! (Maidrn) Lsst Date of Birth
SAME As �IYt� o��RTatZ
Home Addras: SviceE Tlame ��' �� - � � City State Zip Phone Nimtbec
Please list your employment history for ihe previous five (5) yeaz period:
BusinessfEmnlovment Address
su rNc_ C�u�N+ru�� �Mpo��/w�a��sAL�) 3s6 t couaNS�r s�. s�oa�vr�w MN.�s1 z6
List all other officers of the cotporntion:
OFFICER TITLE HOME HOME BUSINESS DATE OF
NAME (Office Held) ADDRESS PHONE PHONE BIRTH J
�AMELA St! PR'�StD�n/,� 356t CoMAnIs�YSt. SNCRrVi�tNMn! 4qo 52tz HAR $. 19.50 /
�At�IEL Si! V , p�CESit�`cA1T356iCUttWJStY5j.5NDRFl/tEWMtJ /t9o-,�2f2 D�c.t3. i94G`�
If business is a partnership, pleue include the following information for each paztner (use additional pages if necessary):
Firs[ Nazne
Home Addcess: Street Name
Middle Initial
(Maiden)
City
L�t
State
Date oFBitth
Phane Number
F'vsc Name Middle Initial {Maiden) Laqt Date of Birth
Address: Saeet Name City State Zip Phone Number
MINNESOTA TAX IDENTIFICAT`ION NUMBER - Pucsuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2
{290.72) (Tax Cleazance; Issuance of Licenses), licensing authorities are required to provide to t6e State of Minnesota Commissioner
of Revenue, the Minnesota business tax identification number and the social security number of each license appiicant.
Under the Minnesota Govemment Data Practices Act and the Federnl Privacy Aet of 1974, we are required to advise you of t6e
following regarding ihe use of the Minnesota Taac ldentification Number:
- This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales,
employer's withholding or motor vehicle excise taxes;
- Upon receiving this infoanation, the licensing authority wiU supply it only to the Minnesota Departmens of Revenue.
However, under t6e Fedenl Exchange of Information Agreement, the Department of Revenue may supply ihis infocmation
to the Intemal Revenue Service.
Minnesota Tax Identificarion Numben (Sales 8c Use Tax Number) may be obtained from the State of Minnesota, Business Records
Department, 10 River Park Plaza (612-296-6181).
Social Securiry Number. 394 - 04 -,�5 52
Minnesota Tax Identification Number: 2 2 g� 3$ d
, 7f a Minnesota Tax Identification Number is not required for ffie business being opernted, indicate so by placing an"X" �
the box. ; '�.;
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� CERTIFICATION OF WORKERS' COMPENSATION �R�1GE PURSUANT TO NIINNESOTA STATUTE I76.I82
I hereby cemfy tfiat I, or my company, am in compiiance wirh the workers' compensation insurance coverage requiremenu of
Minnesota Stamte 276.282, subdivision 2. I also understandthat provision of false information in this certificacionconstiNtes sufficient
grounds for adversc action against aIi ficenses field, including revocarion and suspension of said licenses.
Name of Insurance Company: M N ASS7 bAI �D 121Sk �L_A 1�
i
PoficyNumber. ��{� �hSSilt� Coyemgefrom 6 .�" to �[t3a f�g
I have no employees covered under workers' compensation �*+�TMance
ANY FALSIFICATION OF ANSWERS GTVEN OR MATERIAL SUBMITTED
WILL RESULT IN DENIAL OF THLS APPLICATION
I hereby state that I have answered all of tE�e preceding questions, and that the information contained herein is true and coirect to the
best of my knowledge and belief. I hereby state further that I have received ao money or other consideration, by way of ]oan, gift,
contribution, or otherwise, other than akeady disclosed in the application whicb I herewith submitted.
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Signa D for atl applicarions) Date
Attach to this application:
1) A detailed description ot i6e design, location and square footage of ihe premises to be licensed (site plaa�
The following data s6ould be on the slte plan (preferably on an S 1/Z" a 11" or 8 I2" z 14" paper):
- Name, address, and phone number.
- The scale should be stated such as 1" = 20'. ^N shouid be indicated toward the top.
- Placemenf of sll petfinent features of the interior of t6e licensed faciiity such as seatiag areas, kitchens,
o�ces, repair area, parking, rest rooms, etc.
- If s request is for an addition or ezpansion of the ticensed facitity, indicate both the current area and the
proposed expansiou.
2) A copy of your tease agreement or proof of ownership of the property.