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97-1171� Presented 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 Z9 30 Referred To Council File � y� �� Ordinance # Green Sheet $ �LUTION PAUL, MINNESOTA 3 � Committee: RESOLVED: That application, ID #89316, for a new on Sale Malt ( Ruam Mit Thai Cafe, Inc. DBA Ruam Mit Thai Cafe, Inc. Vongkhamdeng) at 4�5 St. Peter Street, be and the s� l _, ` �A V_ _ � tl• 1� � � �� \\ \ Seer) License by is hereby approved. Requested by Department o£: Office of License. Inspections and Environmental Protection By: Adopted by Counc 1 Adoption Cert'fiec By: Approve by Mayore By: . Date by Council Secretary Date Form Approv by City A ey By: (� � Approved by� Sayor for Submission to Council By: r�� Christine Rozek - 266-9108 I GREEN SHEET � DEPARTMENT DIflECTOR O CITY ATTORNEY FOR ❑ BUDGEf DIRE4TOfl . � MAVOfl (OR ASSISTANn TOTAL # OF SIGNATURE PAGES (CLfP ALL LOCATIONS FOR SIGNATURE) a`l-�111 3?909 IN{TIAVOATE GN CAUNGL qTY CLERK FIN. & MGT. SERVICES �IR. �� Ruam Mit Thai Cafe, Inc. DBA Ruam Mit Thai Cafe, Inc. requests Council approval of their application for a new On Sa1e Malt (Strong Beer) License at 475 St. Peter Street. (ID 1189316) (Manager/Owner - Suthavilay Vongkhamdeng) (A) ar Reject _ PIANNINa GOMMISSI�N __ CIVII SERYICE _ CIB COMMITfEE _ _ STAFF __ DISTRICTGOURT SUPPORTS WHICH COUNCIL O&IECTIVE? PEflSONAL SEHYICE CONTRACTS MUST ANSWEH TFIE FOLLOWING �UESTIONS: 7. Has this persoNfirm ever worked untler a contract for this tlepartment? YES NO 2. Has this persoaNirm ever been a ciry employee? YES NO 3. Ooes tRis person/fkm possess a skill not normally possessed by any current ciry empbyee? YES NO ExR�ain all yes a�swers on separate sheet antl attach to green sheet What. When. Where, Wh�+/: s� �.rL�'33+"�"-a'e:� i ' <�x-*d� "° :'^' ��..�".'fi ,' �.�.1` � � 1�5� IF APPROVEA. IF NOT APPflOVED: TAL AMOUNT OF TRANSACTION $ COS7JREYENUE BUDGE7ED (CIHCLE ONE) YES NO NDIWG SOURCE ACTIYI7Y NUMBER SNCIAL INFOR6fA710N. (EXPLAIN� SAI i FAUL � dRll c�.ass Tu LICENSE APPLICATIOi�T �� CITY QF SAL'�'T PAUL O�ce of Licen�e, L2s�cions z�d Envi ;sc s� pcus� s�ti _ao s:tv»W, xinac.w .vs �6in:sF?:v� r� �F,z)'�-si±a THIS APPLICA7I0,\' IS SUBJECT TO REVIEW BY TF� FI3BLIC PLEASE 7YPE OI2 PRL�'T N L\ K T;�peofLicense(s)beingappliedfor: Malt (3.2) - On Sale License Company:��: Ruam Mit Thai Cafe, Inc. Co;poretion 1 parme.rship t Sole Ptoprietorstup If business is inco ora 06-25-96 rp ted, b ve date of incorporation: Do��Bnsmessa,r. Restaurant BusinessPhone: (61Z) 290-0057 BusinessAddress: 475 Saint Peter Street . Saint Paul MN 55102 Strcet Address Ciry State Zip Betu�eenti�hatcrosss�eeuisthebusinesslocated? 7th $t. dnd St. Peter St. W�chsideoftt�estrezt? St. Peter St AretUepremisesnowoccupied? Yes y�*batT}�peofBusiness� Restdut"dat MailTo.Address: 475 Saint Peter Street Saint Paul Saeet Address ��ry Applicant Informa5on: �azne and Tide: Suthavi l ay F� �� HougAddress: 14189 Flagstone Trail Street Address Suvanphim Vongkhamden �.z�;d�> � Apple Va11ey Ciry DateofBinh; 12-19-57 plar.eofBireh: Vientiane, Laos gomePhone: MN 55102 State Zip President Tide MN ' 55124 State Zip (6l2) 891-3798 Have you ever been convicted of any felony, cri� or violatioa of any city ordinance other tflan traff c? YES ^ NO X Date of arrest A'here� ChazLe: Con��icdo�: Sen+Ence• List tbe names and residenas of chree persons of good motal chazacter, Iiving within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refesed to as to the applicanPs c6aracur: h`� ADDRES5 W: (612) 452-1��'� Bonnhom Thammavongsa 1565 Murphy Parkway, Eagan, MN 55122 H: (612) 688-2910 :..� �sa La., Chanhassen, MN 55317 H: tee List licenses which yon currendy hold, formerly beld, or may have an interest in: Restaurant and Caterinq Have any of the above named licenses ever been revoked? _ YES _ X NO If yes, list the dates and reasons for revocation: Are you going to opente this bvsiness personally? X YFS _ NO If not, who will opente it? First 1:ame Midfie Initiai (Maiden) j,uG HomeAddress: StreC?:ame ... Cih' � Swe Zip I��Tm. i�+i�l Phone Are you ¢oing to have a mana�er or usistant in this business? complete tbe foltox�ing information: Fnt?:zrfx HomeAddras: S:retlux Ci.y Please list your e�lo;ment histery for the pre�•ious five (�) ;�ear period: Sute Dzte of Binh Zip Pnonerumber Business/Em�lo��ment Address Ruam Mit Thai Cafe 544 Saint Peter Street. Saint Paul MN 55109 List all otber officers of tbe corQoradon: OFFICER TITLE HOME HO?�g BUSl?�'ESS D.ATE OF NA�ZE (Office Held) ADDRESS PHO\� PHO\� BIf2TH Thongsy Suvanphim - U:P:, 718 Elizabeth La:; Mpls:, MN 55411 Tel: 522-1085 " 08-12-32 Sommana Monthisane - U.P., 2381 Stone Creek La.eW., Chanhassen, MN 55317 Tel. 470-9147 DOB 08-15-63 If business is a parmersbip, p3ease indude tbe followine info;mation for each parmex (use additional pasas if nuessar}°): Firsc?�urc Mfd31e HomeAddras: S�eu!:zme Fvst?�ame Middie itutiat HomeAddress: Sueet':aIIn ('."aiden) Ciry ('�Saiden) Ciry S,ast Stau I aa State Date of Binh Zip Phone Number Dzte of Birth tin P6one Nwnber MIlv'I�`ESOTA TAX IDEt�"fIFICATTO\ NU'N�ER - Pucsuant to the Laws of Nfinnesota, 1484, Chapter 5�2> Article 8, Secdoa 2(27�.72) (Taz Cleazan^..e; issuance of Licenses), liceasing authorities ac� required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tae ideaafication numbac and the social security numbet of each license applicanG Under the Minnesota Govezn�nt Data Practices Act and the Federal Pri��acy Act of 1474, we ue required to advise you of the following regazding tbe use of the Minoesota Tae Identification Number: - This informafion may be used to deny tbe issuance or renev.•al of your license in the event you owe Atinnesota sales, employei s aTtt�olding or motot vebicle excise taxes; - Upon receiving this information, tl�e Hcensing autbority will supply it only to Ibe Minnesota Depaztment of Revenue. However, under tbe Federal Eachange of Information Ag�ement, the Depart�nt of Revenue may supply ttris information to the Intemal Revenue Service. Minnesota Taz Identification Numbers (Sa3es & Use Taz Number) may be obtained from the State of Minnesota, Business Itecotds Department, IO River Pazk P3a2a (612-296-6181). Social Seciuity A�umber: 586 - 2 6- 247 2 Minnesota Taz Tdenfification A'umber: __ 2771442 2'ES •�\'O, If'the manager is not �e same as tbe operator, plezse �� '1t� 1 '�Sia;Je Iniuzi (?�,tidrn) L.est If a Minnesota Tax Identification Numt�r is not requ'ued for the b¢siness beiag opented, indicate so by placing an "X" in the I10X. - � ��f;�RTI�iCATIO\` OF W ORKERS C0�'iPE:vSATI6N CO��RAGE PL�RSL+,�.\ TO ML'�NESOTA STATt3'SF 1 ib.182 s `' �, �� I hereby cerafy that I, or my company, am in compliance k�ith tbe workers' compensation insurance corenge requiremenu of a4innesota • Statute 176.182, subdivision 2. I also undzrstand tbat provision of f21se i:iformzAOn in this certification constimtes sufficient �oun3s for ad�•erse acUOn aeainst a11 ]icenses beJd includine revocation znd cuspension of s�id licenses. NzmeofIn<urenceCompany: MN Worker Compensation Assiqned Risk Plan Policyi�umber: WC 005948-01 Co�eragefcom 10-14-96 to 10-14-9 I hace no employees covered under ��orkers' co�xnsauon iyurance .�.'�Y FALSIFIC9T10'V OF A.'�5«'ERS GIVEN OR 3LATERLAL SL�B'�IITTED ��II.L RESI3LT I\ DE\ZAL OF THIS �PPLICATIO'�' I 6ereby state that I bave answered all of the prueding quesuons, and that tfie informavon contained herein is true and cosect to the best of my knowledge and belief. I hereby state furtbei that I ha.�e received no money or other consideralion, by way of 3oan, gift, conuibution, or otherwise, other than already diulosed in tSe application n bich I herewith submitted I also undetstand this premise may be inspected by palice, fue, bealtli and other city officiais at 2ny and all timu wSen the business is in operation. _ �`j Si�ature (REQliIkED fb� all Date "*'�ote: I£ ttus application is FoodlLiquor reIated. please conta: t a City of Saint Paul Heal[h Inspector, Ste��e Olson (266-9139), to review plans. If any substanIIal cbanges to swcnue are anticipated, please contact a City of Saint Pavl Plan Ezaminer at 266-9007 ta apply for building permiu. If tl�ere aze any cbanges to the puking lot, flooi spa: e, or for new opemtions, please contact a City of Saint Paul Zaning Inspector aY266-9008. Additional application requiremenks, please attach: A defailed description of the design,location and square footage of the premises to be licensed (sife gian). The follotcing dafa shouSd be on the site plan (preferably on aa 8 iJl" z 11" or 81lZ" x 14" paper): - Name, address, and pbone number. - The scate should be sfated such as i" =?A'. ^'�' should be indicated towud the top. - Placement of all pertinent features of the interior of the licensed faciiify such as seating azeas, kitchens, offices, repair area, Qarkueg, rest rooms, efc - If a teqvest is for an addition at expansion of the licensed facIlitp, indicate bofh the current azea and ihe proposed expansion i A copy of your tease agreement or prooCof ovrnership of the property. i FOR SPECIFIC APPLICATIOiV ItEQiJ�REMENTS, PLEASE SEE REVERSE >>>> � Presented 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 Z9 30 Referred To Council File � y� �� Ordinance # Green Sheet $ �LUTION PAUL, MINNESOTA 3 � Committee: RESOLVED: That application, ID #89316, for a new on Sale Malt ( Ruam Mit Thai Cafe, Inc. DBA Ruam Mit Thai Cafe, Inc. Vongkhamdeng) at 4�5 St. Peter Street, be and the s� l _, ` �A V_ _ � tl• 1� � � �� \\ \ Seer) License by is hereby approved. Requested by Department o£: Office of License. Inspections and Environmental Protection By: Adopted by Counc 1 Adoption Cert'fiec By: Approve by Mayore By: . Date by Council Secretary Date Form Approv by City A ey By: (� � Approved by� Sayor for Submission to Council By: r�� Christine Rozek - 266-9108 I GREEN SHEET � DEPARTMENT DIflECTOR O CITY ATTORNEY FOR ❑ BUDGEf DIRE4TOfl . � MAVOfl (OR ASSISTANn TOTAL # OF SIGNATURE PAGES (CLfP ALL LOCATIONS FOR SIGNATURE) a`l-�111 3?909 IN{TIAVOATE GN CAUNGL qTY CLERK FIN. & MGT. SERVICES �IR. �� Ruam Mit Thai Cafe, Inc. DBA Ruam Mit Thai Cafe, Inc. requests Council approval of their application for a new On Sa1e Malt (Strong Beer) License at 475 St. Peter Street. (ID 1189316) (Manager/Owner - Suthavilay Vongkhamdeng) (A) ar Reject _ PIANNINa GOMMISSI�N __ CIVII SERYICE _ CIB COMMITfEE _ _ STAFF __ DISTRICTGOURT SUPPORTS WHICH COUNCIL O&IECTIVE? PEflSONAL SEHYICE CONTRACTS MUST ANSWEH TFIE FOLLOWING �UESTIONS: 7. Has this persoNfirm ever worked untler a contract for this tlepartment? YES NO 2. Has this persoaNirm ever been a ciry employee? YES NO 3. Ooes tRis person/fkm possess a skill not normally possessed by any current ciry empbyee? YES NO ExR�ain all yes a�swers on separate sheet antl attach to green sheet What. When. Where, Wh�+/: s� �.rL�'33+"�"-a'e:� i ' <�x-*d� "° :'^' ��..�".'fi ,' �.�.1` � � 1�5� IF APPROVEA. IF NOT APPflOVED: TAL AMOUNT OF TRANSACTION $ COS7JREYENUE BUDGE7ED (CIHCLE ONE) YES NO NDIWG SOURCE ACTIYI7Y NUMBER SNCIAL INFOR6fA710N. (EXPLAIN� SAI i FAUL � dRll c�.ass Tu LICENSE APPLICATIOi�T �� CITY QF SAL'�'T PAUL O�ce of Licen�e, L2s�cions z�d Envi ;sc s� pcus� s�ti _ao s:tv»W, xinac.w .vs �6in:sF?:v� r� �F,z)'�-si±a THIS APPLICA7I0,\' IS SUBJECT TO REVIEW BY TF� FI3BLIC PLEASE 7YPE OI2 PRL�'T N L\ K T;�peofLicense(s)beingappliedfor: Malt (3.2) - On Sale License Company:��: Ruam Mit Thai Cafe, Inc. Co;poretion 1 parme.rship t Sole Ptoprietorstup If business is inco ora 06-25-96 rp ted, b ve date of incorporation: Do��Bnsmessa,r. Restaurant BusinessPhone: (61Z) 290-0057 BusinessAddress: 475 Saint Peter Street . Saint Paul MN 55102 Strcet Address Ciry State Zip Betu�eenti�hatcrosss�eeuisthebusinesslocated? 7th $t. dnd St. Peter St. W�chsideoftt�estrezt? St. Peter St AretUepremisesnowoccupied? Yes y�*batT}�peofBusiness� Restdut"dat MailTo.Address: 475 Saint Peter Street Saint Paul Saeet Address ��ry Applicant Informa5on: �azne and Tide: Suthavi l ay F� �� HougAddress: 14189 Flagstone Trail Street Address Suvanphim Vongkhamden �.z�;d�> � Apple Va11ey Ciry DateofBinh; 12-19-57 plar.eofBireh: Vientiane, Laos gomePhone: MN 55102 State Zip President Tide MN ' 55124 State Zip (6l2) 891-3798 Have you ever been convicted of any felony, cri� or violatioa of any city ordinance other tflan traff c? YES ^ NO X Date of arrest A'here� ChazLe: Con��icdo�: Sen+Ence• List tbe names and residenas of chree persons of good motal chazacter, Iiving within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refesed to as to the applicanPs c6aracur: h`� ADDRES5 W: (612) 452-1��'� Bonnhom Thammavongsa 1565 Murphy Parkway, Eagan, MN 55122 H: (612) 688-2910 :..� �sa La., Chanhassen, MN 55317 H: tee List licenses which yon currendy hold, formerly beld, or may have an interest in: Restaurant and Caterinq Have any of the above named licenses ever been revoked? _ YES _ X NO If yes, list the dates and reasons for revocation: Are you going to opente this bvsiness personally? X YFS _ NO If not, who will opente it? First 1:ame Midfie Initiai (Maiden) j,uG HomeAddress: StreC?:ame ... Cih' � Swe Zip I��Tm. i�+i�l Phone Are you ¢oing to have a mana�er or usistant in this business? complete tbe foltox�ing information: Fnt?:zrfx HomeAddras: S:retlux Ci.y Please list your e�lo;ment histery for the pre�•ious five (�) ;�ear period: Sute Dzte of Binh Zip Pnonerumber Business/Em�lo��ment Address Ruam Mit Thai Cafe 544 Saint Peter Street. Saint Paul MN 55109 List all otber officers of tbe corQoradon: OFFICER TITLE HOME HO?�g BUSl?�'ESS D.ATE OF NA�ZE (Office Held) ADDRESS PHO\� PHO\� BIf2TH Thongsy Suvanphim - U:P:, 718 Elizabeth La:; Mpls:, MN 55411 Tel: 522-1085 " 08-12-32 Sommana Monthisane - U.P., 2381 Stone Creek La.eW., Chanhassen, MN 55317 Tel. 470-9147 DOB 08-15-63 If business is a parmersbip, p3ease indude tbe followine info;mation for each parmex (use additional pasas if nuessar}°): Firsc?�urc Mfd31e HomeAddras: S�eu!:zme Fvst?�ame Middie itutiat HomeAddress: Sueet':aIIn ('."aiden) Ciry ('�Saiden) Ciry S,ast Stau I aa State Date of Binh Zip Phone Number Dzte of Birth tin P6one Nwnber MIlv'I�`ESOTA TAX IDEt�"fIFICATTO\ NU'N�ER - Pucsuant to the Laws of Nfinnesota, 1484, Chapter 5�2> Article 8, Secdoa 2(27�.72) (Taz Cleazan^..e; issuance of Licenses), liceasing authorities ac� required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tae ideaafication numbac and the social security numbet of each license applicanG Under the Minnesota Govezn�nt Data Practices Act and the Federal Pri��acy Act of 1474, we ue required to advise you of the following regazding tbe use of the Minoesota Tae Identification Number: - This informafion may be used to deny tbe issuance or renev.•al of your license in the event you owe Atinnesota sales, employei s aTtt�olding or motot vebicle excise taxes; - Upon receiving this information, tl�e Hcensing autbority will supply it only to Ibe Minnesota Depaztment of Revenue. However, under tbe Federal Eachange of Information Ag�ement, the Depart�nt of Revenue may supply ttris information to the Intemal Revenue Service. Minnesota Taz Identification Numbers (Sa3es & Use Taz Number) may be obtained from the State of Minnesota, Business Itecotds Department, IO River Pazk P3a2a (612-296-6181). Social Seciuity A�umber: 586 - 2 6- 247 2 Minnesota Taz Tdenfification A'umber: __ 2771442 2'ES •�\'O, If'the manager is not �e same as tbe operator, plezse �� '1t� 1 '�Sia;Je Iniuzi (?�,tidrn) L.est If a Minnesota Tax Identification Numt�r is not requ'ued for the b¢siness beiag opented, indicate so by placing an "X" in the I10X. - � ��f;�RTI�iCATIO\` OF W ORKERS C0�'iPE:vSATI6N CO��RAGE PL�RSL+,�.\ TO ML'�NESOTA STATt3'SF 1 ib.182 s `' �, �� I hereby cerafy that I, or my company, am in compliance k�ith tbe workers' compensation insurance corenge requiremenu of a4innesota • Statute 176.182, subdivision 2. I also undzrstand tbat provision of f21se i:iformzAOn in this certification constimtes sufficient �oun3s for ad�•erse acUOn aeainst a11 ]icenses beJd includine revocation znd cuspension of s�id licenses. NzmeofIn<urenceCompany: MN Worker Compensation Assiqned Risk Plan Policyi�umber: WC 005948-01 Co�eragefcom 10-14-96 to 10-14-9 I hace no employees covered under ��orkers' co�xnsauon iyurance .�.'�Y FALSIFIC9T10'V OF A.'�5«'ERS GIVEN OR 3LATERLAL SL�B'�IITTED ��II.L RESI3LT I\ DE\ZAL OF THIS �PPLICATIO'�' I 6ereby state that I bave answered all of the prueding quesuons, and that tfie informavon contained herein is true and cosect to the best of my knowledge and belief. I hereby state furtbei that I ha.�e received no money or other consideralion, by way of 3oan, gift, conuibution, or otherwise, other than already diulosed in tSe application n bich I herewith submitted I also undetstand this premise may be inspected by palice, fue, bealtli and other city officiais at 2ny and all timu wSen the business is in operation. _ �`j Si�ature (REQliIkED fb� all Date "*'�ote: I£ ttus application is FoodlLiquor reIated. please conta: t a City of Saint Paul Heal[h Inspector, Ste��e Olson (266-9139), to review plans. If any substanIIal cbanges to swcnue are anticipated, please contact a City of Saint Pavl Plan Ezaminer at 266-9007 ta apply for building permiu. If tl�ere aze any cbanges to the puking lot, flooi spa: e, or for new opemtions, please contact a City of Saint Paul Zaning Inspector aY266-9008. Additional application requiremenks, please attach: A defailed description of the design,location and square footage of the premises to be licensed (sife gian). The follotcing dafa shouSd be on the site plan (preferably on aa 8 iJl" z 11" or 81lZ" x 14" paper): - Name, address, and pbone number. - The scate should be sfated such as i" =?A'. ^'�' should be indicated towud the top. - Placement of all pertinent features of the interior of the licensed faciiify such as seating azeas, kitchens, offices, repair area, Qarkueg, rest rooms, efc - If a teqvest is for an addition at expansion of the licensed facIlitp, indicate bofh the current azea and ihe proposed expansion i A copy of your tease agreement or prooCof ovrnership of the property. i FOR SPECIFIC APPLICATIOiV ItEQiJ�REMENTS, PLEASE SEE REVERSE >>>> � Presented 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 Z9 30 Referred To Council File � y� �� Ordinance # Green Sheet $ �LUTION PAUL, MINNESOTA 3 � Committee: RESOLVED: That application, ID #89316, for a new on Sale Malt ( Ruam Mit Thai Cafe, Inc. DBA Ruam Mit Thai Cafe, Inc. Vongkhamdeng) at 4�5 St. Peter Street, be and the s� l _, ` �A V_ _ � tl• 1� � � �� \\ \ Seer) License by is hereby approved. Requested by Department o£: Office of License. Inspections and Environmental Protection By: Adopted by Counc 1 Adoption Cert'fiec By: Approve by Mayore By: . Date by Council Secretary Date Form Approv by City A ey By: (� � Approved by� Sayor for Submission to Council By: r�� Christine Rozek - 266-9108 I GREEN SHEET � DEPARTMENT DIflECTOR O CITY ATTORNEY FOR ❑ BUDGEf DIRE4TOfl . � MAVOfl (OR ASSISTANn TOTAL # OF SIGNATURE PAGES (CLfP ALL LOCATIONS FOR SIGNATURE) a`l-�111 3?909 IN{TIAVOATE GN CAUNGL qTY CLERK FIN. & MGT. SERVICES �IR. �� Ruam Mit Thai Cafe, Inc. DBA Ruam Mit Thai Cafe, Inc. requests Council approval of their application for a new On Sa1e Malt (Strong Beer) License at 475 St. Peter Street. (ID 1189316) (Manager/Owner - Suthavilay Vongkhamdeng) (A) ar Reject _ PIANNINa GOMMISSI�N __ CIVII SERYICE _ CIB COMMITfEE _ _ STAFF __ DISTRICTGOURT SUPPORTS WHICH COUNCIL O&IECTIVE? PEflSONAL SEHYICE CONTRACTS MUST ANSWEH TFIE FOLLOWING �UESTIONS: 7. Has this persoNfirm ever worked untler a contract for this tlepartment? YES NO 2. Has this persoaNirm ever been a ciry employee? YES NO 3. Ooes tRis person/fkm possess a skill not normally possessed by any current ciry empbyee? YES NO ExR�ain all yes a�swers on separate sheet antl attach to green sheet What. When. Where, Wh�+/: s� �.rL�'33+"�"-a'e:� i ' <�x-*d� "° :'^' ��..�".'fi ,' �.�.1` � � 1�5� IF APPROVEA. IF NOT APPflOVED: TAL AMOUNT OF TRANSACTION $ COS7JREYENUE BUDGE7ED (CIHCLE ONE) YES NO NDIWG SOURCE ACTIYI7Y NUMBER SNCIAL INFOR6fA710N. (EXPLAIN� SAI i FAUL � dRll c�.ass Tu LICENSE APPLICATIOi�T �� CITY QF SAL'�'T PAUL O�ce of Licen�e, L2s�cions z�d Envi ;sc s� pcus� s�ti _ao s:tv»W, xinac.w .vs �6in:sF?:v� r� �F,z)'�-si±a THIS APPLICA7I0,\' IS SUBJECT TO REVIEW BY TF� FI3BLIC PLEASE 7YPE OI2 PRL�'T N L\ K T;�peofLicense(s)beingappliedfor: Malt (3.2) - On Sale License Company:��: Ruam Mit Thai Cafe, Inc. Co;poretion 1 parme.rship t Sole Ptoprietorstup If business is inco ora 06-25-96 rp ted, b ve date of incorporation: Do��Bnsmessa,r. Restaurant BusinessPhone: (61Z) 290-0057 BusinessAddress: 475 Saint Peter Street . Saint Paul MN 55102 Strcet Address Ciry State Zip Betu�eenti�hatcrosss�eeuisthebusinesslocated? 7th $t. dnd St. Peter St. W�chsideoftt�estrezt? St. Peter St AretUepremisesnowoccupied? Yes y�*batT}�peofBusiness� Restdut"dat MailTo.Address: 475 Saint Peter Street Saint Paul Saeet Address ��ry Applicant Informa5on: �azne and Tide: Suthavi l ay F� �� HougAddress: 14189 Flagstone Trail Street Address Suvanphim Vongkhamden �.z�;d�> � Apple Va11ey Ciry DateofBinh; 12-19-57 plar.eofBireh: Vientiane, Laos gomePhone: MN 55102 State Zip President Tide MN ' 55124 State Zip (6l2) 891-3798 Have you ever been convicted of any felony, cri� or violatioa of any city ordinance other tflan traff c? YES ^ NO X Date of arrest A'here� ChazLe: Con��icdo�: Sen+Ence• List tbe names and residenas of chree persons of good motal chazacter, Iiving within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, who may be refesed to as to the applicanPs c6aracur: h`� ADDRES5 W: (612) 452-1��'� Bonnhom Thammavongsa 1565 Murphy Parkway, Eagan, MN 55122 H: (612) 688-2910 :..� �sa La., Chanhassen, MN 55317 H: tee List licenses which yon currendy hold, formerly beld, or may have an interest in: Restaurant and Caterinq Have any of the above named licenses ever been revoked? _ YES _ X NO If yes, list the dates and reasons for revocation: Are you going to opente this bvsiness personally? X YFS _ NO If not, who will opente it? First 1:ame Midfie Initiai (Maiden) j,uG HomeAddress: StreC?:ame ... Cih' � Swe Zip I��Tm. i�+i�l Phone Are you ¢oing to have a mana�er or usistant in this business? complete tbe foltox�ing information: Fnt?:zrfx HomeAddras: S:retlux Ci.y Please list your e�lo;ment histery for the pre�•ious five (�) ;�ear period: Sute Dzte of Binh Zip Pnonerumber Business/Em�lo��ment Address Ruam Mit Thai Cafe 544 Saint Peter Street. Saint Paul MN 55109 List all otber officers of tbe corQoradon: OFFICER TITLE HOME HO?�g BUSl?�'ESS D.ATE OF NA�ZE (Office Held) ADDRESS PHO\� PHO\� BIf2TH Thongsy Suvanphim - U:P:, 718 Elizabeth La:; Mpls:, MN 55411 Tel: 522-1085 " 08-12-32 Sommana Monthisane - U.P., 2381 Stone Creek La.eW., Chanhassen, MN 55317 Tel. 470-9147 DOB 08-15-63 If business is a parmersbip, p3ease indude tbe followine info;mation for each parmex (use additional pasas if nuessar}°): Firsc?�urc Mfd31e HomeAddras: S�eu!:zme Fvst?�ame Middie itutiat HomeAddress: Sueet':aIIn ('."aiden) Ciry ('�Saiden) Ciry S,ast Stau I aa State Date of Binh Zip Phone Number Dzte of Birth tin P6one Nwnber MIlv'I�`ESOTA TAX IDEt�"fIFICATTO\ NU'N�ER - Pucsuant to the Laws of Nfinnesota, 1484, Chapter 5�2> Article 8, Secdoa 2(27�.72) (Taz Cleazan^..e; issuance of Licenses), liceasing authorities ac� required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tae ideaafication numbac and the social security numbet of each license applicanG Under the Minnesota Govezn�nt Data Practices Act and the Federal Pri��acy Act of 1474, we ue required to advise you of the following regazding tbe use of the Minoesota Tae Identification Number: - This informafion may be used to deny tbe issuance or renev.•al of your license in the event you owe Atinnesota sales, employei s aTtt�olding or motot vebicle excise taxes; - Upon receiving this information, tl�e Hcensing autbority will supply it only to Ibe Minnesota Depaztment of Revenue. However, under tbe Federal Eachange of Information Ag�ement, the Depart�nt of Revenue may supply ttris information to the Intemal Revenue Service. Minnesota Taz Identification Numbers (Sa3es & Use Taz Number) may be obtained from the State of Minnesota, Business Itecotds Department, IO River Pazk P3a2a (612-296-6181). Social Seciuity A�umber: 586 - 2 6- 247 2 Minnesota Taz Tdenfification A'umber: __ 2771442 2'ES •�\'O, If'the manager is not �e same as tbe operator, plezse �� '1t� 1 '�Sia;Je Iniuzi (?�,tidrn) L.est If a Minnesota Tax Identification Numt�r is not requ'ued for the b¢siness beiag opented, indicate so by placing an "X" in the I10X. - � ��f;�RTI�iCATIO\` OF W ORKERS C0�'iPE:vSATI6N CO��RAGE PL�RSL+,�.\ TO ML'�NESOTA STATt3'SF 1 ib.182 s `' �, �� I hereby cerafy that I, or my company, am in compliance k�ith tbe workers' compensation insurance corenge requiremenu of a4innesota • Statute 176.182, subdivision 2. I also undzrstand tbat provision of f21se i:iformzAOn in this certification constimtes sufficient �oun3s for ad�•erse acUOn aeainst a11 ]icenses beJd includine revocation znd cuspension of s�id licenses. NzmeofIn<urenceCompany: MN Worker Compensation Assiqned Risk Plan Policyi�umber: WC 005948-01 Co�eragefcom 10-14-96 to 10-14-9 I hace no employees covered under ��orkers' co�xnsauon iyurance .�.'�Y FALSIFIC9T10'V OF A.'�5«'ERS GIVEN OR 3LATERLAL SL�B'�IITTED ��II.L RESI3LT I\ DE\ZAL OF THIS �PPLICATIO'�' I 6ereby state that I bave answered all of the prueding quesuons, and that tfie informavon contained herein is true and cosect to the best of my knowledge and belief. I hereby state furtbei that I ha.�e received no money or other consideralion, by way of 3oan, gift, conuibution, or otherwise, other than already diulosed in tSe application n bich I herewith submitted I also undetstand this premise may be inspected by palice, fue, bealtli and other city officiais at 2ny and all timu wSen the business is in operation. _ �`j Si�ature (REQliIkED fb� all Date "*'�ote: I£ ttus application is FoodlLiquor reIated. please conta: t a City of Saint Paul Heal[h Inspector, Ste��e Olson (266-9139), to review plans. If any substanIIal cbanges to swcnue are anticipated, please contact a City of Saint Pavl Plan Ezaminer at 266-9007 ta apply for building permiu. If tl�ere aze any cbanges to the puking lot, flooi spa: e, or for new opemtions, please contact a City of Saint Paul Zaning Inspector aY266-9008. Additional application requiremenks, please attach: A defailed description of the design,location and square footage of the premises to be licensed (sife gian). The follotcing dafa shouSd be on the site plan (preferably on aa 8 iJl" z 11" or 81lZ" x 14" paper): - Name, address, and pbone number. - The scate should be sfated such as i" =?A'. ^'�' should be indicated towud the top. - Placement of all pertinent features of the interior of the licensed faciiify such as seating azeas, kitchens, offices, repair area, Qarkueg, rest rooms, efc - If a teqvest is for an addition at expansion of the licensed facIlitp, indicate bofh the current azea and ihe proposed expansion i A copy of your tease agreement or prooCof ovrnership of the property. i FOR SPECIFIC APPLICATIOiV ItEQiJ�REMENTS, PLEASE SEE REVERSE >>>>