96-650r`°. C'� ry
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Council File # � S b
Ordinance #
Green Sheet # `�' `����
Presented By
Referred To
�
PAUL, MINNESOTA
�
Com[nittee: Date
1 RESOLVED: That application (ID #73176) for a Parkinq Lot/Ramp License by 401 E. 4th
2 Bldg Partnership DBA 401 E. 4th Bldg Partnership (Phil Paquette) at 1551
3 Payne Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 eas Navs Absent
7 BZakey
S Guerin Office of License Insoections and
9 Harri
10 Meaar � �— Environmenta� Protection
11 Re'ttman
12 Thune
13 Bostrom � (
15 gY • _ ��e' �'�.Fl � .��L �v`�
16 Adopted by Council: Date � ---�-
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
2� - /
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Y� /�
22 B ��� I � / /�/ ��BY� �%i' .v.uF-�CJ .l�ac4
23 Approved by Mayor: Date �2 t"tY
24
Z5 Approved by Mayor for Submission to
26 $y. ��� Council
27
By:
qf_-<_50
DEPAflTMENT/OFFIGFJCAUNCIL DATEINITIATED GREEN SHEE N� 35293
LIEP/Licensing INIT7AIIDATE MITtAilDATE
CANTACT PEq50N b PHONE O DEPARTMEM DIRE O CIiY COUNqL
Christine Rozek, 266-9108 A���'N �CITVATfORNEY �CITYCLERK
MUST BE ON CO(}ry�tL AGENDA BY (DAS� qO��FOR O BUOGEf DIAECTOR O Flt3. & MGL SERVICES Dlii.
r'OT hearing: 6� OpOEfi OMAYOR(ORASSISTANn �
TOTAL # OF SIGNATURE PAGES " (CUP ALL LOCATIONS FOR SIGNATUR�
ACftON REQUESTED:
401 E 4th Bldg Partnership DBA 401 E 4th Bldg Partnership requests Council,approval of its
application for a Parking Lot/Ramp License at 401 4th Street East (ID ��73176).
RECOMMENDATIONS: Approve (A) or Rejett (R) PEpSONAL SERVICE CONTRACTS MUST ANSWER TXE FOLLOWING QUESTIONS:
_ PLqNNING CpMM1S$ION __ CIVIL SERVICE COMMISSION 1. Has this personfirm ever worketl uMer a CoMrac[ for Mis departrnerrt? -
_ qB COMMITfEE _ YES NO
_ STnFF � 2. Has this personlfirm ever been a city empioyee?
— YES NO
_ DISTRIC7 COUR7 _ 3. Does this erson/firm
p possess a skill no[ normally possessed by any curteM city emplqree?
SUPPOFiTS WHICN COUNCIL OBJECTIVE? YES NO
Explain all yes answars on separete sheet and attech to green sheet
INITIATING PROBLEM. ISSUE. OPPOqTUN17Y (VJho. W�ai. When, Where, WhyJ:
ADVANTAGES IFAPPpOVED:
DISADVANTAGES IFAPPROVED:
s
DISADVANTAQES IF NOT APPROVED:
��:�� � ?���
TO7AL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDINCa SOURCE ACTIVITY NUMBER
GINANCIAL INFORMATION: (EXPLAIN)
Greensheet # 35293 l.I.E.P. REVIEW CHECKLIST Date: 4/19/96 / a(. -�$b
In Tr3CkBi'? ApP'n Received / ApP'n Processed
License ID # 73176 LicenseType: a Parkinz Lot/Ram�
Company Name: GO1 E 4th Blde Paxtnership DBA: Game
Business Addresss: 401 4th St E Business Phone: 771-1000
ContactName/Address: Phil Paquette. 1551 Pavne Ave. 101 Home Phone: 771-1000
Date to Councii
Public Hearing I
Notice Sent to �
Notice Sent to I
Department/
City Attomey
Environmental
Health
Fire
License
Police
���.1-�.
/ '�T/�
Date Inspections
�f•xI•�1�
Labels Ordered: /d��
District Council #: 7
Ward #: �
Comments
O.k,
N��+�
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tt.1 p�AFbe��L-�� � -
Site Plan Received: "—�
lease Received: —
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CLASS III
LICENSE APPLICATION
CTTY OF SAINT PA
om,a or��w�, v�rion:
and Environmental Proleaion
3505� eaa st sunc 100
Svv�hW.Mivrcsau 55102
(61n1b69090 fu(612)2669124
THIS APPLICATION IS SUBIECI' TO REVIEW BY Tf� PUBLIC
. )/'_�:':h_ 41 .
Type of License(s) being applied for:
Company Name:
f Parmuship ! So(e
If business is incorporated give date of incorporation:
Doi�o Business As: �d 1 � '! � �J
Business Address:
Business Phone• 02 �9 d —Yb'G Y
SneetAddrus � � City � State 2ip
Between what cxoss stxeets is the business located� �f�h N"� "6 � f���Which side of the street� �_
Are the premises now
Mail To Address:
Applicant Infon
Name and Tifle:
ed? '�/� 5 What Type of
?�F �� .#�,
Address
N��
c�
City
�
State
Zip
Home Address:
Fvst � _ Middle v (Maiden) Last Title
Strcetaaarus / p � City� • State Zip
Date of Birth: ��— �3 Place of Birth: � 1� wh"'� �✓' ��� Home P6one: _�� 7 r i'1 yli
Have you ever been convicted of any felony, crime or violauon of any ciry ordinance ott�er than ttaffic? YES _, NO �
Date of arrest: �� Where?
Chazge: �—
Conviction: �' Senteoce:
List the names and residences of three persons of good moral chazacter, living within the Twin CiGes Metro Area, not related to the
applicant or financially interested in the premises or business, who may be ceferred to as to the applicant's chazacter: y
NAME „ _. ADDRESS � 3" — y� PH` ONE
��,
List licenses
you currenQy hold, fom�erly held or may have an interest in:
Are Xou goin�to operate this business personally? _�iYES �'O If not, who will operate it?
t.�;amo �a�t
(Maiden) Last
Home Addrefs: Street Name ' Ciry / � State � tip
7llo
�� 3 �Y 3
Date of Birth
�y�—Yly�
Phont Number
Have any of the above nazned licenses ever been revoked?,_ YES �NO If yes, list the dates and reasons for revocatioa
Are you going to have a managec oc assistant in this business?
complete the following infomia[ion:
Frst Narne
Home Add[ess: Stteei Name
BusinesslEmplovment
Please list your employment 6istory for the previous five (5) yeaz period:
A�l�imcc
If the manager is not the same as the operato pl c� ... �
�t�-GS�
I.ast Date of Birth
Sute Zip Phone Number
List all othec officers of the corporadon:
OFFICER TI'fLE AOME HOME BUSINESS DATE OF
Iy'AME (Office Held) ADURESS PHONE PHONE BIRTH
If business
f� �-
� FrstNamd
Ho Addres
� M, � J
Fast Name
Middle Initial
Idev
na;aaie�
the following information for each partner (use additional pages if
��7 7 � �e1�7
I25I
��3 GQ
State
p Date
7 O"
Zip Phc�ni
� C —!/,` 9 DateofBirth
�r� �
Home Address: Sheel Name Ciry Slate Zip Phone Number
MINNESOTA TAX IDENPfI-"iCA7'ION NUMBER - Pursuant to the Iaws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72)
(Ta�c Cleazance; Issuance of Licenses), licensing authorities aze req3ued to provide to the Scate of Minnesota Commissioner of Revenue,
the Minnesota business tae idenufication number and the social security number of each license applicant.
Under the Minnesota Govemment Data Practices Act aad the Federal Privacy Act of 1974, we aze required to advise you of the followiog
regazding the use of the Minnesota Tac Identification Number:
- This inforniation may be used to deny the issuance or�r�newal of your license in ihe even[ you owe Minnesota sales, employer's
withholding or motor vehicle excise taxes;
- Upon receivipg this infocmavon, ihe &censing anthority will supply it only to tl�e Minnesota Depaztment of Revenue. However,
under the Federal Exchange of Informaaon AgreemenG �e Departwent of Revenue may supply this information to the Intemal
Revenue Secvice. �
Minnesota Taz Identification Numbers (Sales & Use Ta�c Number) may be obtained from the State of Minnesota, Business Records
Departmen4 10 River Pazk Plaza (612-296-6181).
Social Security Number:
Minnesota Taz Identification Numbe[:
� If a Minnesota Ta�c Identification Numbet is not required for the business being operated, indicate so by p(acing an "X" in the
boz.
is a paztnership, please
Street
_ YES �! NO
(Maiden)
City_
, �� - a� a- —�YG v
� �CATION OF WORKERS' COMPENSATION COVERAGE PURSUANT TO MINNESOTA STATUTE 176.18T G ���
reby certify that I, or my com�any, am in comptiance with the workers compensation insurance coverage requiremeou of Minnesota
S�atute 176.182, subdivision 2. I also understand that provision of false iofortnaaon in this certi�cation coostitutes sufficient grounds for
adverse action against all licenses held, including revocafion and suspension of said licenses.
Name of Insurance Company: �/�YV� rtr e��, �
PolicyNumber: �J — C D 7�j � Q a 3—1
Coverage from �/) - /J ^ �/ 5 to �V — �� �
I have no e�loyees covered under workers' compensation insurance
� �p�l— 7�if /��, ��I✓G�'�`
ANY FALSIFICA'I'ION OF ANS WERS GIVEI� OR MATERIAL SUBNIITTED
WII,L RESULT IN DENIAL OF TfIIS APPLICATION
I hereby state ihac I have answered all of the preceding questions, and that the information coatained herein is true and cosect to the best
of my knowledge and belief. I hereby state furthet that I have received no money or o[her consideraUOn, by way of loan, gifr, cootribufion,
or otherwise, othet [han atready disclosed in the applica[ion wfrich I herewith submitted. I also understand ttis premise may be inspec[ed
by police, fire, fiealth and o[her city officials at any and all Gmes when the business is in operation.
Signature
all applications)
J/
�
Date
**Note: If this application is Food/Liquor related, please coutact a City of Saint Pau] Health Inspector, Steve Olson (266-9139), to review
plans.
If any substanaai changes to structure are anticipated, please contact a City of Saint Paul Plan F�;aminer at 266-9007 to apply for
building permits.
If tt�ere aze any changes to the pazking lot, flooc space, or for new opera6ons, please contact a Ciry of Saint Paul Zoning Inspector
at266-9008.
Additional application requirements, please attach:
A detailed description of the design, location and square footage of the premises to be licensed (site pian).
The following data should be on the sife plan (preferably on an 8]/2" x 11" or 812" x 14" paper):
- Name, address, and phone number.
- The scale should be stated such as 1" _?A'. ^N shoutd be indicated towazd the top.
- Placement of alt pertinent features of the interior of the 6censed 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 cutrent azea and the groposed
expansioa
A cppy ot your iease agreement or proof of ownership oF ihe property.
FOR SPECIFIC APPLICATION REQUIREYIENTS, PLEASE SEE REVERSE >>>>,