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97-1090Council File # \� – �d� Ordinance # Green Sheet # � � l f � 1 2 3 �. : .. _ .. ,_ Presented By Referred To Committee: Date 3� RESOLVED: That application (ID #71944) for a Cigarette, Off Sale Mak, and a Grocery-C License by Wa Joe Vu DBA American Asian Grocery Store (Wa Vang, Owner) at 33 George Street East be and the same is hereby approved. 4 5 xequested by Department of: 6 Yeas Nays Absent 7 B ak� 8 Bostran �� 9 Harris / 10 Mega� � 11 Morton 12 T un� 13 Col� � � 14 15 16 Adopted by Council: Date � r ( 17 18 Adoption Certified by Council Secretary 19 20 (� 21 By: ��}_� 22 23 Approved by Mayor: Date � 24 25 � 26 By: 27 RESOLUTION OF SAINT PAU�, MINNESOTA Office of License, Insnections and Envix'onmental Protection By: l`si�i ��•y� ✓—! �1� � Form Approved by City Attorney BY� ✓ O Approved by Mayor for Submission to co,��i By: °t'1 -�oqo DEPAPTMENLOFFlCE/COUNpL DATE INITIATED 3 7 9 7 3 LIEPfLicensin GREEN SHEE CIXJTACT PERSON & PNONE INITIAWATE INITIAWATE � OEPARTMENT DIRECTOR O CITY COUNCIL Christine Ro2ek, 266-9108 A �� N OCITYAl70RNEV OCITYCLERK NUNBEfl FOR MU5T BE ON CAUNCILAGENDA Y(D T/E) pOUTING � BU�GEf DIRECTOR a FIN. & MGT. SEFVICES DIR. For hearin : 3 �"� � ONDEfl � MAVOR (ORASSISTANf) O TOTAL # OF SIGNATURE PACaES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION RE�UESTED: Wa Joe Vu DBA American Asian Grocery Store requests Council approval of its application for a Cigarette, Off Sale Malt, and a Grocery-C License located at 33 George Street East (ID 9t71944). pECOMMENDATiONS: approve (A) or Reject (R) pERSONAL SERYICE CANTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever wo�ked u�der a contract for this department? _ GIB COMMITfEE _ YES NO _ S7AFF 2- Has this person/firm ever been a ciry employee? — YES NO _ oiSTHIC7COURr _ 3. Does this person/firm possess a skill not normally possessed by any current city employee? SUPPORTSWHICHCOUNCILOHJECSIVE? YES NO Explain all yes answers on separate sheet and ettach to green sheet lNIT1ATING PftOBLEM, ISSUE, OPPORTUNIN(Who, What, When, WNere, Why)� �� JUL tJ8 J�97 �� ADVANTACaESIFAPPflOVED k,� �°�uaG�u,%�>sii .. ..,;a C'tt8€2 (.� Gs i:;:: f DISADVANTAGES IF APPROVED. ' DISADVANTAGES IF NOTAPPROVED' 70TAL AMOUNT OF 7RANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO PUNDIfiG SOURCE A.CTIVITV NUMBER FINANCIAL INFOFN7ATION (EXPLAIN) S.�MT T/10L � t1AA CLASS III LICENSE APPLICATJO� f �Pvr'or�y � �7/y�� et't - \oq c CITY OF SAIIv'T PAUL Offict of Licrnx, In�xtions z�d Em�'vonme�al Protcaion ';: A Paa Sv 5u,u Yq 5>is hul. N�nttsua 5!ILL` (613) 2A69N> fu lEl]� •(�.c�+� �c�� ° �� PLEASE TYPE OR PRA'T L\ L�K � a/ 7 �� Ca�t� �. v G ,I T}pe of License{s) being a, lied for: li t ' 3 `��' G ��^ C( � u '� ' � (°J Company ::au�: �' i G �✓ i itn� G i2 = C�7Z a 2- Cccycr,acion / Parsership 1 Solt RoprietonT_'p If business is incorporated, give date of in:orporauon: Doin2 Busiozss As: � C� BusinessPhone: .2�-�- �a�S BusinessAddress: '33 EliST �ED7�6E �i2E� ST �,g�tL rinJ. SSIG�.. Sveec Address Ciry Staie Zip Betueen what cross streett is the business located? ��_�� GE�r7 j�-/)')CCi'1 Vlhich side of ihe suee[? IdUr2lfi � Are tbe premises now octupied? �_ R'hat T}pe of Business? � h�' D(�' E�Y ;vlail To .4ddress: 3"3 C ED2 G E ST� ��.�YU L M..� SS/ OZ Svxt Addreu Ciiy Siate Zip Applicant Information: \ame and Tide: Lc! A Fi.zt Ho� Address: �? � � —L � ASiddie @taiden) Lzs� rd� Svac Addras Ciq Sia�t Zip Dau of B'uth: � 1� 1 s 3 Place of Birth: � F}'D-S Home Phone: � 1 Z�'7'7.6 -6 �) � r � Have you n�er been convicted of any felony, cri� or ti•iolation of any city ordinaoce o�ber �hao traffic? YES,_ KO,,,� Datc of azrest Chazge: Y Coa�•iction: Sentence: List the names and residences of thzee pasons of good mora] chazacter, licing withio the Twin Cities Metro Area, not relaud to the applicaat ot fwaociaily inuresud in the premises or business, x•ho may be referred to as to tbe applicaut's cbazactcr: XAME ADDRESS PHO'�'E Are you going to opetate this business pecsonally? � YES , NO If not, who will opetau it? � First frarrc Middle Inival (?.iaiden) Lace Date of Hinh V�'bere? Home Addras: Streu \atrc - Ciry Su�e tip PTone Numbct List licenses which you curtendy Lold, formerly held, or may ha�•e an interest in: � �� . Ha�•e any of the aboce na:sred lianses ever beea revoked? _ YES � NO If yes, fist the dates and reasons for revocation: Are ��ou coine to ha�e a manaeer or z�r.stant in rhis business? - 5"ES XO It �he r.unage.r is not Lhe sarie u ti`�e opzrs;�'. };'.e::•_ cocnpleu the following infocmation: �� _�� O � _ . � � Frst!:ame � >.islleWoal (tilaiden) Latt DamotBinh � 8�. �TY� tW�nl U 6 EKY�T J i �,ru �, ,c�nr .S�'70,h 77 6- 6�1 � �Home.4ddress: Scr.a\ene Ci.y Suie Zip PhoneNumSer Ple�<e list you em; lo;ment histor� fer the Qrecious fi�•e (_) ;ear period: �uciness/Em�lo��ment ddre� ,,/��' L _ IT�T . List all othec officers of the corporaden: OFFICER TTTLE HO!.� \A.YiE (�ce He1c) ADDRESS HO?�� BUSL'�'ESS DATE OF PHO�E FHO�"E BIRTK If business is a parmership, please in;l�de the follou•ing information for eac6 partner (use additional pages if decessary): Fvse �ame Mid31: i.:ual (?".aiden) tast Date of Birt}� Home Addresf: Saea':une Ciry Stam Zip Phone Number � Fvst:�ame Mid3leLtina{ (Mvden) Isst Dueo[B¢th HomeAddrss: Sveet:�ame Ciry Sute Zip P`�one!�umber ML'�°:�'ESOTA TAX IDE.'�"IgICAI'f0\ ?�UIvIDER - Pucsuaat to the Laws of?.Tinnesot� 1984, Chapter 502, Artide 8, Sectioo 2(270.72) (faz Clearance; Issuance of Liceases), liceosing au�Dorities are roqu'ued to provide to tbe Stau of Minnesota Commissiona of Recenue, tbe Mimesota business tu ideotification numbet and ehe sx,ial securiry numxr of each Iicense applicanc L'nder the h2innesota Govemment Data Pracrices Act and tbe Federal Pri��acy Act of 1994, we aze required to ad� ise }'ou of the followiog regazding the use of the ivfinnesota Tvc Identificauon Numxr: - This informazion may be used to deny ttx issuance or renewal of your 6cense in the event you owe Minnesota sales, employei s withholding or motor vehicle ezcise tazes; - t?pon receiving tius infoTmasion, �e licensing authority W�ill supply it only to t6e Minneso�a Depa�ent of Revenue. However, under the Federal Ezchange of Informatioo Agreement, the DepaRment of Re�•enue may supply this information to t6e Incemal Reti'enue Servicr - - — - !viinnesota 7az IdenfiScation ;.�umben (Sa1es & Use Taz \umber) may be obtaiced from the Stau of ?Vlinnesota, Busioess Records Departsoent, 10 River Pazk Plaza (612-246-6181). Sociat Security ;�`umber. ��-� O_ • O l 6 3 ?vlinnesota Ta�c IdenGficadon Tumber. ."Sa+� �y 3 t �� If a Miaoesoea Taz Idencificatioa Number is not required fot �e busiaess being operaeed, indicate so by placing aa "X" in che boz. �""C�`RTIFTCATIO\ OF WORKERS' CO��iPE:�SATION CO�EFLAGE Pll2SU.4\Z' TO MII�T'ESOTA STATUTE 176.182 I hereby cercify tt�at I, oz my company, azn in compliance �'ic� the v.•orkeTS insurance co��erage requiremeau of ?�4innesota S�atute 176.132, subdi� isien?. I a1w understand that pro�'isiea of f�lse inform2tion in this eertification constitutes sufficient ,goun3s for ad�erse acueo aetinst all licen�es held iocludir.g.*ecocation ��d susperciea of szid licences. �::me of Insurznce Company: Policy \umber: Coeecage from I ha� e no emplo;�ees co�•ered under w•o:kers' comxosation u2urance m A\Y FALSffIC�TIO\ OF A\S�i�RS GI�'EN OR'�'L�TERIAL SL'B'4IITTED �iZI,L RESULT I\ DE.\IAL OF THIS APPLICATIO:d a�-�O�jO I hereby state tbat I hzce ansu�ered all of the precediog quesao�s, and that [he inforcnation contained herein is true and conect to [he best of my l:noW ]edge and belief. I hereby state fiuil�er that I ha� e receiced no mone}� or other consideration, by H ay of losa, gift, contribuuon, or othen�`ice, o:�er than already diulosed in the apglication F Sich I berew�ith submitted. I also understand this premise may be inspec2ed b} pelice, Fize, heath and o?her city officias at zcy aod aII u�s u hen the business is in eperadon. Siooa:ure (1tEQli1RED for all applications) /�� Date *'1ote: if [his applicauon is Food/Liquor related, please cooa t a Ciq� of Saint Paul Health Inspector, Steve Olson (266-9139), to re��iew plans. lf anq substaneial changes to strucnue am anticipaeed, please cootact a Ciry of Saint Paul Plan Ezaminer at 266-9007 to apply for building permiu. If tbere are aoy c6anges to the pazking lot, floor spa:e, or for new openaons, please contact a Ciry of Saint Paul Zoniag Inspector az 266-9008. Additional application requirementr, please attach: A detailed descrSptlon of the design, location and square tootage of the premises to be licensed (site plan). The foAowing data should be on the site ptan {preferably on an 8�/2" x 11" or S 1!l" x 14" paper): • !vame, address, and phone number. - T'he scale should be stated such u 1" = 2(}'. ^\ should be indicated toward the top. - Ptacement of alI pertinent features ot the interior of the licensed facility such as seating areas, kitc6ens, offices, repair area, parldng, rest rooms, etc - If a request is for an addition or ezpansion of the licensed facility, indicate both the current azea and the proposed eapansion A copy of }'our lease agreement or proof of o�'nership of the property. FOR SPECIFIC APPLICATIO�I REQUIREDiE:�'TS, PLEASE SEE REVERSE »» Council File # \� – �d� Ordinance # Green Sheet # � � l f � 1 2 3 �. : .. _ .. ,_ Presented By Referred To Committee: Date 3� RESOLVED: That application (ID #71944) for a Cigarette, Off Sale Mak, and a Grocery-C License by Wa Joe Vu DBA American Asian Grocery Store (Wa Vang, Owner) at 33 George Street East be and the same is hereby approved. 4 5 xequested by Department of: 6 Yeas Nays Absent 7 B ak� 8 Bostran �� 9 Harris / 10 Mega� � 11 Morton 12 T un� 13 Col� � � 14 15 16 Adopted by Council: Date � r ( 17 18 Adoption Certified by Council Secretary 19 20 (� 21 By: ��}_� 22 23 Approved by Mayor: Date � 24 25 � 26 By: 27 RESOLUTION OF SAINT PAU�, MINNESOTA Office of License, Insnections and Envix'onmental Protection By: l`si�i ��•y� ✓—! �1� � Form Approved by City Attorney BY� ✓ O Approved by Mayor for Submission to co,��i By: °t'1 -�oqo DEPAPTMENLOFFlCE/COUNpL DATE INITIATED 3 7 9 7 3 LIEPfLicensin GREEN SHEE CIXJTACT PERSON & PNONE INITIAWATE INITIAWATE � OEPARTMENT DIRECTOR O CITY COUNCIL Christine Ro2ek, 266-9108 A �� N OCITYAl70RNEV OCITYCLERK NUNBEfl FOR MU5T BE ON CAUNCILAGENDA Y(D T/E) pOUTING � BU�GEf DIRECTOR a FIN. & MGT. SEFVICES DIR. For hearin : 3 �"� � ONDEfl � MAVOR (ORASSISTANf) O TOTAL # OF SIGNATURE PACaES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION RE�UESTED: Wa Joe Vu DBA American Asian Grocery Store requests Council approval of its application for a Cigarette, Off Sale Malt, and a Grocery-C License located at 33 George Street East (ID 9t71944). pECOMMENDATiONS: approve (A) or Reject (R) pERSONAL SERYICE CANTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever wo�ked u�der a contract for this department? _ GIB COMMITfEE _ YES NO _ S7AFF 2- Has this person/firm ever been a ciry employee? — YES NO _ oiSTHIC7COURr _ 3. Does this person/firm possess a skill not normally possessed by any current city employee? SUPPORTSWHICHCOUNCILOHJECSIVE? YES NO Explain all yes answers on separate sheet and ettach to green sheet lNIT1ATING PftOBLEM, ISSUE, OPPORTUNIN(Who, What, When, WNere, Why)� �� JUL tJ8 J�97 �� ADVANTACaESIFAPPflOVED k,� �°�uaG�u,%�>sii .. ..,;a C'tt8€2 (.� Gs i:;:: f DISADVANTAGES IF APPROVED. ' DISADVANTAGES IF NOTAPPROVED' 70TAL AMOUNT OF 7RANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO PUNDIfiG SOURCE A.CTIVITV NUMBER FINANCIAL INFOFN7ATION (EXPLAIN) S.�MT T/10L � t1AA CLASS III LICENSE APPLICATJO� f �Pvr'or�y � �7/y�� et't - \oq c CITY OF SAIIv'T PAUL Offict of Licrnx, In�xtions z�d Em�'vonme�al Protcaion ';: A Paa Sv 5u,u Yq 5>is hul. N�nttsua 5!ILL` (613) 2A69N> fu lEl]� •(�.c�+� �c�� ° �� PLEASE TYPE OR PRA'T L\ L�K � a/ 7 �� Ca�t� �. v G ,I T}pe of License{s) being a, lied for: li t ' 3 `��' G ��^ C( � u '� ' � (°J Company ::au�: �' i G �✓ i itn� G i2 = C�7Z a 2- Cccycr,acion / Parsership 1 Solt RoprietonT_'p If business is incorporated, give date of in:orporauon: Doin2 Busiozss As: � C� BusinessPhone: .2�-�- �a�S BusinessAddress: '33 EliST �ED7�6E �i2E� ST �,g�tL rinJ. SSIG�.. Sveec Address Ciry Staie Zip Betueen what cross streett is the business located? ��_�� GE�r7 j�-/)')CCi'1 Vlhich side of ihe suee[? IdUr2lfi � Are tbe premises now octupied? �_ R'hat T}pe of Business? � h�' D(�' E�Y ;vlail To .4ddress: 3"3 C ED2 G E ST� ��.�YU L M..� SS/ OZ Svxt Addreu Ciiy Siate Zip Applicant Information: \ame and Tide: Lc! A Fi.zt Ho� Address: �? � � —L � ASiddie @taiden) Lzs� rd� Svac Addras Ciq Sia�t Zip Dau of B'uth: � 1� 1 s 3 Place of Birth: � F}'D-S Home Phone: � 1 Z�'7'7.6 -6 �) � r � Have you n�er been convicted of any felony, cri� or ti•iolation of any city ordinaoce o�ber �hao traffic? YES,_ KO,,,� Datc of azrest Chazge: Y Coa�•iction: Sentence: List the names and residences of thzee pasons of good mora] chazacter, licing withio the Twin Cities Metro Area, not relaud to the applicaat ot fwaociaily inuresud in the premises or business, x•ho may be referred to as to tbe applicaut's cbazactcr: XAME ADDRESS PHO'�'E Are you going to opetate this business pecsonally? � YES , NO If not, who will opetau it? � First frarrc Middle Inival (?.iaiden) Lace Date of Hinh V�'bere? Home Addras: Streu \atrc - Ciry Su�e tip PTone Numbct List licenses which you curtendy Lold, formerly held, or may ha�•e an interest in: � �� . Ha�•e any of the aboce na:sred lianses ever beea revoked? _ YES � NO If yes, fist the dates and reasons for revocation: Are ��ou coine to ha�e a manaeer or z�r.stant in rhis business? - 5"ES XO It �he r.unage.r is not Lhe sarie u ti`�e opzrs;�'. };'.e::•_ cocnpleu the following infocmation: �� _�� O � _ . � � Frst!:ame � >.islleWoal (tilaiden) Latt DamotBinh � 8�. �TY� tW�nl U 6 EKY�T J i �,ru �, ,c�nr .S�'70,h 77 6- 6�1 � �Home.4ddress: Scr.a\ene Ci.y Suie Zip PhoneNumSer Ple�<e list you em; lo;ment histor� fer the Qrecious fi�•e (_) ;ear period: �uciness/Em�lo��ment ddre� ,,/��' L _ IT�T . List all othec officers of the corporaden: OFFICER TTTLE HO!.� \A.YiE (�ce He1c) ADDRESS HO?�� BUSL'�'ESS DATE OF PHO�E FHO�"E BIRTK If business is a parmership, please in;l�de the follou•ing information for eac6 partner (use additional pages if decessary): Fvse �ame Mid31: i.:ual (?".aiden) tast Date of Birt}� Home Addresf: Saea':une Ciry Stam Zip Phone Number � Fvst:�ame Mid3leLtina{ (Mvden) Isst Dueo[B¢th HomeAddrss: Sveet:�ame Ciry Sute Zip P`�one!�umber ML'�°:�'ESOTA TAX IDE.'�"IgICAI'f0\ ?�UIvIDER - Pucsuaat to the Laws of?.Tinnesot� 1984, Chapter 502, Artide 8, Sectioo 2(270.72) (faz Clearance; Issuance of Liceases), liceosing au�Dorities are roqu'ued to provide to tbe Stau of Minnesota Commissiona of Recenue, tbe Mimesota business tu ideotification numbet and ehe sx,ial securiry numxr of each Iicense applicanc L'nder the h2innesota Govemment Data Pracrices Act and tbe Federal Pri��acy Act of 1994, we aze required to ad� ise }'ou of the followiog regazding the use of the ivfinnesota Tvc Identificauon Numxr: - This informazion may be used to deny ttx issuance or renewal of your 6cense in the event you owe Minnesota sales, employei s withholding or motor vehicle ezcise tazes; - t?pon receiving tius infoTmasion, �e licensing authority W�ill supply it only to t6e Minneso�a Depa�ent of Revenue. However, under the Federal Ezchange of Informatioo Agreement, the DepaRment of Re�•enue may supply this information to t6e Incemal Reti'enue Servicr - - — - !viinnesota 7az IdenfiScation ;.�umben (Sa1es & Use Taz \umber) may be obtaiced from the Stau of ?Vlinnesota, Busioess Records Departsoent, 10 River Pazk Plaza (612-246-6181). Sociat Security ;�`umber. ��-� O_ • O l 6 3 ?vlinnesota Ta�c IdenGficadon Tumber. ."Sa+� �y 3 t �� If a Miaoesoea Taz Idencificatioa Number is not required fot �e busiaess being operaeed, indicate so by placing aa "X" in che boz. �""C�`RTIFTCATIO\ OF WORKERS' CO��iPE:�SATION CO�EFLAGE Pll2SU.4\Z' TO MII�T'ESOTA STATUTE 176.182 I hereby cercify tt�at I, oz my company, azn in compliance �'ic� the v.•orkeTS insurance co��erage requiremeau of ?�4innesota S�atute 176.132, subdi� isien?. I a1w understand that pro�'isiea of f�lse inform2tion in this eertification constitutes sufficient ,goun3s for ad�erse acueo aetinst all licen�es held iocludir.g.*ecocation ��d susperciea of szid licences. �::me of Insurznce Company: Policy \umber: Coeecage from I ha� e no emplo;�ees co�•ered under w•o:kers' comxosation u2urance m A\Y FALSffIC�TIO\ OF A\S�i�RS GI�'EN OR'�'L�TERIAL SL'B'4IITTED �iZI,L RESULT I\ DE.\IAL OF THIS APPLICATIO:d a�-�O�jO I hereby state tbat I hzce ansu�ered all of the precediog quesao�s, and that [he inforcnation contained herein is true and conect to [he best of my l:noW ]edge and belief. I hereby state fiuil�er that I ha� e receiced no mone}� or other consideration, by H ay of losa, gift, contribuuon, or othen�`ice, o:�er than already diulosed in the apglication F Sich I berew�ith submitted. I also understand this premise may be inspec2ed b} pelice, Fize, heath and o?her city officias at zcy aod aII u�s u hen the business is in eperadon. Siooa:ure (1tEQli1RED for all applications) /�� Date *'1ote: if [his applicauon is Food/Liquor related, please cooa t a Ciq� of Saint Paul Health Inspector, Steve Olson (266-9139), to re��iew plans. lf anq substaneial changes to strucnue am anticipaeed, please cootact a Ciry of Saint Paul Plan Ezaminer at 266-9007 to apply for building permiu. If tbere are aoy c6anges to the pazking lot, floor spa:e, or for new openaons, please contact a Ciry of Saint Paul Zoniag Inspector az 266-9008. Additional application requirementr, please attach: A detailed descrSptlon of the design, location and square tootage of the premises to be licensed (site plan). The foAowing data should be on the site ptan {preferably on an 8�/2" x 11" or S 1!l" x 14" paper): • !vame, address, and phone number. - T'he scale should be stated such u 1" = 2(}'. ^\ should be indicated toward the top. - Ptacement of alI pertinent features ot the interior of the licensed facility such as seating areas, kitc6ens, offices, repair area, parldng, rest rooms, etc - If a request is for an addition or ezpansion of the licensed facility, indicate both the current azea and the proposed eapansion A copy of }'our lease agreement or proof of o�'nership of the property. FOR SPECIFIC APPLICATIO�I REQUIREDiE:�'TS, PLEASE SEE REVERSE »» Council File # \� – �d� Ordinance # Green Sheet # � � l f � 1 2 3 �. : .. _ .. ,_ Presented By Referred To Committee: Date 3� RESOLVED: That application (ID #71944) for a Cigarette, Off Sale Mak, and a Grocery-C License by Wa Joe Vu DBA American Asian Grocery Store (Wa Vang, Owner) at 33 George Street East be and the same is hereby approved. 4 5 xequested by Department of: 6 Yeas Nays Absent 7 B ak� 8 Bostran �� 9 Harris / 10 Mega� � 11 Morton 12 T un� 13 Col� � � 14 15 16 Adopted by Council: Date � r ( 17 18 Adoption Certified by Council Secretary 19 20 (� 21 By: ��}_� 22 23 Approved by Mayor: Date � 24 25 � 26 By: 27 RESOLUTION OF SAINT PAU�, MINNESOTA Office of License, Insnections and Envix'onmental Protection By: l`si�i ��•y� ✓—! �1� � Form Approved by City Attorney BY� ✓ O Approved by Mayor for Submission to co,��i By: °t'1 -�oqo DEPAPTMENLOFFlCE/COUNpL DATE INITIATED 3 7 9 7 3 LIEPfLicensin GREEN SHEE CIXJTACT PERSON & PNONE INITIAWATE INITIAWATE � OEPARTMENT DIRECTOR O CITY COUNCIL Christine Ro2ek, 266-9108 A �� N OCITYAl70RNEV OCITYCLERK NUNBEfl FOR MU5T BE ON CAUNCILAGENDA Y(D T/E) pOUTING � BU�GEf DIRECTOR a FIN. & MGT. SEFVICES DIR. For hearin : 3 �"� � ONDEfl � MAVOR (ORASSISTANf) O TOTAL # OF SIGNATURE PACaES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION RE�UESTED: Wa Joe Vu DBA American Asian Grocery Store requests Council approval of its application for a Cigarette, Off Sale Malt, and a Grocery-C License located at 33 George Street East (ID 9t71944). pECOMMENDATiONS: approve (A) or Reject (R) pERSONAL SERYICE CANTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever wo�ked u�der a contract for this department? _ GIB COMMITfEE _ YES NO _ S7AFF 2- Has this person/firm ever been a ciry employee? — YES NO _ oiSTHIC7COURr _ 3. Does this person/firm possess a skill not normally possessed by any current city employee? SUPPORTSWHICHCOUNCILOHJECSIVE? YES NO Explain all yes answers on separate sheet and ettach to green sheet lNIT1ATING PftOBLEM, ISSUE, OPPORTUNIN(Who, What, When, WNere, Why)� �� JUL tJ8 J�97 �� ADVANTACaESIFAPPflOVED k,� �°�uaG�u,%�>sii .. ..,;a C'tt8€2 (.� Gs i:;:: f DISADVANTAGES IF APPROVED. ' DISADVANTAGES IF NOTAPPROVED' 70TAL AMOUNT OF 7RANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO PUNDIfiG SOURCE A.CTIVITV NUMBER FINANCIAL INFOFN7ATION (EXPLAIN) S.�MT T/10L � t1AA CLASS III LICENSE APPLICATJO� f �Pvr'or�y � �7/y�� et't - \oq c CITY OF SAIIv'T PAUL Offict of Licrnx, In�xtions z�d Em�'vonme�al Protcaion ';: A Paa Sv 5u,u Yq 5>is hul. N�nttsua 5!ILL` (613) 2A69N> fu lEl]� •(�.c�+� �c�� ° �� PLEASE TYPE OR PRA'T L\ L�K � a/ 7 �� Ca�t� �. v G ,I T}pe of License{s) being a, lied for: li t ' 3 `��' G ��^ C( � u '� ' � (°J Company ::au�: �' i G �✓ i itn� G i2 = C�7Z a 2- Cccycr,acion / Parsership 1 Solt RoprietonT_'p If business is incorporated, give date of in:orporauon: Doin2 Busiozss As: � C� BusinessPhone: .2�-�- �a�S BusinessAddress: '33 EliST �ED7�6E �i2E� ST �,g�tL rinJ. SSIG�.. Sveec Address Ciry Staie Zip Betueen what cross streett is the business located? ��_�� GE�r7 j�-/)')CCi'1 Vlhich side of ihe suee[? IdUr2lfi � Are tbe premises now octupied? �_ R'hat T}pe of Business? � h�' D(�' E�Y ;vlail To .4ddress: 3"3 C ED2 G E ST� ��.�YU L M..� SS/ OZ Svxt Addreu Ciiy Siate Zip Applicant Information: \ame and Tide: Lc! A Fi.zt Ho� Address: �? � � —L � ASiddie @taiden) Lzs� rd� Svac Addras Ciq Sia�t Zip Dau of B'uth: � 1� 1 s 3 Place of Birth: � F}'D-S Home Phone: � 1 Z�'7'7.6 -6 �) � r � Have you n�er been convicted of any felony, cri� or ti•iolation of any city ordinaoce o�ber �hao traffic? YES,_ KO,,,� Datc of azrest Chazge: Y Coa�•iction: Sentence: List the names and residences of thzee pasons of good mora] chazacter, licing withio the Twin Cities Metro Area, not relaud to the applicaat ot fwaociaily inuresud in the premises or business, x•ho may be referred to as to tbe applicaut's cbazactcr: XAME ADDRESS PHO'�'E Are you going to opetate this business pecsonally? � YES , NO If not, who will opetau it? � First frarrc Middle Inival (?.iaiden) Lace Date of Hinh V�'bere? Home Addras: Streu \atrc - Ciry Su�e tip PTone Numbct List licenses which you curtendy Lold, formerly held, or may ha�•e an interest in: � �� . Ha�•e any of the aboce na:sred lianses ever beea revoked? _ YES � NO If yes, fist the dates and reasons for revocation: Are ��ou coine to ha�e a manaeer or z�r.stant in rhis business? - 5"ES XO It �he r.unage.r is not Lhe sarie u ti`�e opzrs;�'. };'.e::•_ cocnpleu the following infocmation: �� _�� O � _ . � � Frst!:ame � >.islleWoal (tilaiden) Latt DamotBinh � 8�. �TY� tW�nl U 6 EKY�T J i �,ru �, ,c�nr .S�'70,h 77 6- 6�1 � �Home.4ddress: Scr.a\ene Ci.y Suie Zip PhoneNumSer Ple�<e list you em; lo;ment histor� fer the Qrecious fi�•e (_) ;ear period: �uciness/Em�lo��ment ddre� ,,/��' L _ IT�T . List all othec officers of the corporaden: OFFICER TTTLE HO!.� \A.YiE (�ce He1c) ADDRESS HO?�� BUSL'�'ESS DATE OF PHO�E FHO�"E BIRTK If business is a parmership, please in;l�de the follou•ing information for eac6 partner (use additional pages if decessary): Fvse �ame Mid31: i.:ual (?".aiden) tast Date of Birt}� Home Addresf: Saea':une Ciry Stam Zip Phone Number � Fvst:�ame Mid3leLtina{ (Mvden) Isst Dueo[B¢th HomeAddrss: Sveet:�ame Ciry Sute Zip P`�one!�umber ML'�°:�'ESOTA TAX IDE.'�"IgICAI'f0\ ?�UIvIDER - Pucsuaat to the Laws of?.Tinnesot� 1984, Chapter 502, Artide 8, Sectioo 2(270.72) (faz Clearance; Issuance of Liceases), liceosing au�Dorities are roqu'ued to provide to tbe Stau of Minnesota Commissiona of Recenue, tbe Mimesota business tu ideotification numbet and ehe sx,ial securiry numxr of each Iicense applicanc L'nder the h2innesota Govemment Data Pracrices Act and tbe Federal Pri��acy Act of 1994, we aze required to ad� ise }'ou of the followiog regazding the use of the ivfinnesota Tvc Identificauon Numxr: - This informazion may be used to deny ttx issuance or renewal of your 6cense in the event you owe Minnesota sales, employei s withholding or motor vehicle ezcise tazes; - t?pon receiving tius infoTmasion, �e licensing authority W�ill supply it only to t6e Minneso�a Depa�ent of Revenue. However, under the Federal Ezchange of Informatioo Agreement, the DepaRment of Re�•enue may supply this information to t6e Incemal Reti'enue Servicr - - — - !viinnesota 7az IdenfiScation ;.�umben (Sa1es & Use Taz \umber) may be obtaiced from the Stau of ?Vlinnesota, Busioess Records Departsoent, 10 River Pazk Plaza (612-246-6181). Sociat Security ;�`umber. ��-� O_ • O l 6 3 ?vlinnesota Ta�c IdenGficadon Tumber. ."Sa+� �y 3 t �� If a Miaoesoea Taz Idencificatioa Number is not required fot �e busiaess being operaeed, indicate so by placing aa "X" in che boz. �""C�`RTIFTCATIO\ OF WORKERS' CO��iPE:�SATION CO�EFLAGE Pll2SU.4\Z' TO MII�T'ESOTA STATUTE 176.182 I hereby cercify tt�at I, oz my company, azn in compliance �'ic� the v.•orkeTS insurance co��erage requiremeau of ?�4innesota S�atute 176.132, subdi� isien?. I a1w understand that pro�'isiea of f�lse inform2tion in this eertification constitutes sufficient ,goun3s for ad�erse acueo aetinst all licen�es held iocludir.g.*ecocation ��d susperciea of szid licences. �::me of Insurznce Company: Policy \umber: Coeecage from I ha� e no emplo;�ees co�•ered under w•o:kers' comxosation u2urance m A\Y FALSffIC�TIO\ OF A\S�i�RS GI�'EN OR'�'L�TERIAL SL'B'4IITTED �iZI,L RESULT I\ DE.\IAL OF THIS APPLICATIO:d a�-�O�jO I hereby state tbat I hzce ansu�ered all of the precediog quesao�s, and that [he inforcnation contained herein is true and conect to [he best of my l:noW ]edge and belief. I hereby state fiuil�er that I ha� e receiced no mone}� or other consideration, by H ay of losa, gift, contribuuon, or othen�`ice, o:�er than already diulosed in the apglication F Sich I berew�ith submitted. I also understand this premise may be inspec2ed b} pelice, Fize, heath and o?her city officias at zcy aod aII u�s u hen the business is in eperadon. Siooa:ure (1tEQli1RED for all applications) /�� Date *'1ote: if [his applicauon is Food/Liquor related, please cooa t a Ciq� of Saint Paul Health Inspector, Steve Olson (266-9139), to re��iew plans. lf anq substaneial changes to strucnue am anticipaeed, please cootact a Ciry of Saint Paul Plan Ezaminer at 266-9007 to apply for building permiu. If tbere are aoy c6anges to the pazking lot, floor spa:e, or for new openaons, please contact a Ciry of Saint Paul Zoniag Inspector az 266-9008. Additional application requirementr, please attach: A detailed descrSptlon of the design, location and square tootage of the premises to be licensed (site plan). The foAowing data should be on the site ptan {preferably on an 8�/2" x 11" or S 1!l" x 14" paper): • !vame, address, and phone number. - T'he scale should be stated such u 1" = 2(}'. ^\ should be indicated toward the top. - Ptacement of alI pertinent features ot the interior of the licensed facility such as seating areas, kitc6ens, offices, repair area, parldng, rest rooms, etc - If a request is for an addition or ezpansion of the licensed facility, indicate both the current azea and the proposed eapansion A copy of }'our lease agreement or proof of o�'nership of the property. FOR SPECIFIC APPLICATIO�I REQUIREDiE:�'TS, PLEASE SEE REVERSE »»