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97-1366Council File f 7 �� Ordinance # Green Sheet # 50253 1 2 3 4 5 b 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ,_ � , ,� _ , . Presented By � Referred To CITY MINNESOTA Com[nittee: Date 3q RESOLVED: That application, ID #24244, for a Parking Lot/Ramp License by J. M. ICeefe Co. DBA Reefe Company Parking, (Donald Reefe, Jr., Presideat), at 137 Robert Street South. be and the same is hereby approved. Requested by Department of: Office of License Inapections and Envirorimenta7 Protection $Y: � � �'�?'G.6 Form Approved by City Att ne //' i � Adopted by Council: Date �y �., \�, . �,`�5�'1 By: �, !hq � �.: n �— ""7 Adoption Certified by Council Secretary Approved by Mayor for Submission to � Council By: cl- . � Bys Approved by Mayor: Date _ , � �2L�`t4' By: .� ( i N°_ 50253 g � - �3�� DEPA(iiMEN7AFFlCE/CWNGL DATE INITIATED LIEP GREEN SHEE CONTACT PERSON 8 PHONE MITIRVDATE INITIALlDATE QOEPARTMENTpIRECTOF �CINCOUNdL ChristiAe A. Rozek - 266-9108 ASSIGN aCITYATTORNEV �C�TYCLERK MUST BE ON CAUNCIL AGENDA BY (OATE) NUMBER i0i1 O BUDGET OIflECTOR � FIN. & MGT. SERVICES OIP. NOUTiNG Hearing: ��( Z�j'� OFOEfl Q MAVOR (OR ASSISTPNT� O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) � ACTION HEQUESTED: J. M. Reefe Co. DBA Reefe Company Parking requests Council approval of their application for a Parking Lot/Ramp License, (Donald Keefe,'Jr., President), ID 4F24244, at 137 Robert Street South.. RECAMMENDASiOnS: npp�ova (A) m fleject (A) pERSONAL SERVICE CONTqACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ GIVIL SERVICE COMMISSION �� Has thi5 per50n/fifin ev¢r wori(ed under a cont2ct fOr this Oepartment? _ p6 COMMITfEE _ YES NO _ STAFf 2. Has this person/firm eve� been a ciry employee? — YES NO _ DiSiRiCi COUai _ 3. Does this person/firm pOSSess a skill not normally possessed by any current city employee? SUPPORTS WMCH COUNCIL 0H3ECTIVE'+ YES NO EXplain ell yes ensWers on aeperete eheet entl eHach to green sheet INITIAiING PflOBLEM. ISSUE. OPPORTVNITY (Who. WheA, When. Where. Why)' AWANTAGESIFAPPROVEO: Co�W� ,��t� �star �� i , 1997 DISADVANTAGE$ IF APPROVED' DISADVANTAGES IF NOT APPROVED. TOTAL AMOUNT OFTRANSACTION $ COST/REVENUE BUDGE7ED (CIRCLE ONE) VES NO FUNDIWG SOURCE ACTIVITV NUMBER FINANCtAt INFOAHiAT10N (EXPIAIN) g � -���� � � CLASS III LICENSE APPLICATION THIS APPLICATION IS SUBJECT TO REVIEW BY THHEE PUBLIC CTTY OF SAIi�T PALZ Office of License, Iar��.ions and Environmmtzl Pro:ection 35J St Pctc St Stite 30J S£.^v?mlBS'v��ota 531� (63R)1669Mr0 fyeC61])i6S�1]4 PLEASE TYPE OR PRINT IN INK Type of License(s} being applied fo� �L-f'J�.� ��� � g 3(�� Company Name: t� ,�� Y E� / sole Avpriaonh;p If business is incorporated, give date of incorporation: � � y 7�' Doing Business As: � 2.2 -e_ Ge . (,✓�� �!2 (� � �: k c; (!' .s�'� ` 0 97J� r � Business Phone: Business Address: ��/ �. � a 6 e.r T S � .5� �d� l ,M ..1 � Strret Address . CiTy � State Zip Between what cross streets is the bvsiness located? - �e �e � T v�r� �ai r!t � te f � �ch side of the street? W e� � Are the premises now occupied7 /� c What Type of Business? P� ✓Z �+� 9 L e� Mail To Address: y y/ a �a �a rl2 � S �...t nf �CY.n a�t /�L. �..y SS ��/ � S�n naa��„ c;ry s� Zsp Applicant Information: V NameandTifle: YIQ��' ��jt_ Ke��-c_. �� lP��S F� �aai� ��a�> � ra� Home Address: y y� d �d � a r!2 ! S ��1 .� �� y .y, � cr r�-. i•�,J SS' `/Y � StreetAddrev CitY State Zip Date of Birth: �I •� `/ �T o Place of Birth: _�j �.�� . L� y. sSa - � 9 Y 9 Home Phone: Have you ever been com�eted of any felony, crime or ��iolation of any city ordinance other than tra�c? YES NO � � Date of arrest: Charge: _ Conviction: Where? Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Mefro Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicanPs character: NAME L1St I1CCIl5CS V.'}llC}3 }'O 9.� � ?1l, Have any of the above ADDRESS currrndy hol� formerly held, or sT' . R'L � 9 9�, 5� everbeenrevoked? an interest in: �_5i �� YES nl GJw�6..5 If yes, list the dates PH023E 3�s w0.t) -�j forrevocation: i 2/78/97 Are you going to operate this business personally? Fssri \'sne �liddle Lutial NO If not, who will operate it? Home Addrs�: Stiut \eme Are you going to have a manager or assistant in this business7 please complete the foi3oning information: F�t?:�_ HomeAddicss: Stxcetlh�e CiTy Please Iis[ gour employment history for the pre��ious five (5) } ear period: Business/Emplovment Address ��es ��e.� i - J.�. keE�--�. G� � Da�e of Birth M� Zip Pnone \�umSer If the manager is not the same as the ope=ator, � Statc List all other officers of the coiporation: OFFICER TITLE HOME HOME BUSINESS DATE OF � NAME (Office Held) ADDRESS PHONE PHONE BIF2TH ��1� J�C�e�-�.-(/.� yYra 1Pd/�uzt5 L,.� s5a->9y9 s�>-�9�5� 5'�v��/ If business is a partnership, please include the following information for each partner (use additional pages if necessary): F;rn �� Home Address: Strcet Neme FvstN�e Hame Addrev: Strcc[ Name City CiTy Las[ State Zip I.ast Smte 7zp Da;e of Bir3 Zip Puonc:��tmbct Date of Birt} Phon< Tum6cr Date of BinL Phone Number MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72) (Ta�c Cleazance; Issuance of Licenses), licensing authorities ue required to provide to the State oPMinnesota Commissioner of Revenue, the Mumesoca business tax identification number and tl�e social security number of each license applicant. Under the Mmnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the follow�ing regarding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Iviinnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, ihe Department of Revenue may supply this information to the Intemal Revenue Senice. Muuiesota Taz Idenlification Numbeis (Sa]es & Use Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6181). Social Securiry Number: �I �I � O° ���� Minnesota Tax ldenti5cation Number: yI ` I Z� °�� � YES _ (�leidrnj Cin _ YES vyddle v,;ti� �;a�,� (4teidcn) Midd{e Snilial q? -i.��� If a Minnesots TaY Ident�cation Number is not required for the business being operated, indicate so by placing an "X" in the box. �_; 2/18.97 �% "/�:�<o CEkTIFICA7ION OF WORKERS' CO':vtPENSATION CO VERAGE PURSUANT TO MII��TTESOTA STATUTE 176.182 I hereb}� certify that I, or mp company, azn in compliance with the �3•oc};ers' compensation 'v-vsurance corerage requiremrnts of MvZnesota S`�tute 176.182, subdi��ision 2. I also unders[and that provision of false information in this cefufication constitutes s�cient grounds for zdverse zcuon against all licenses held, including revoc2lion znd suspension of said licenses. I�Tazne of Insurance Company: Policyl�TUmber. � 3 f � (� C� (J .S e — t� � % S Q Coverage frorm �d ! 1 7 to / e ( I have no emplopees covered under workers' compensation insw-ance (T?SITIALS) ANY FALSIFICATION OF ANSWERS GNEIv OR MATERIAL SUBMIT`I'ED WILI, RESULT IN DENIELL OF THIS APPLICATION I hereby state that I have ansa�ered all of tl�e preceding questions, and that the infotmation contained herein is true and correct to the b:st of my know]edge and belief I hereby sfate further that i have received no money or other consideration by way of loan, gift, contributioa or ol�eiu�ise, other than already disciosed in the application which I herewith submittxl I also understand this premise may be inspected by pe':ice, fire, health and other ciry officials at any and all times when the business is in operation. � Signature (REQU7RED for W e will accept paJ�ment by eash, cbeck (made payable to City of Saint Paul) or credit card (M/C or Visa). �� �'/97 Dafe IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLOWINGINFORb1ATION: �MasterCud � Visa TiON DATE: � � � � ACCOUNP NIJMBER: ' � � � � � � � � � � � � � � � � of for all Date *•Nofe: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re�iew plans. If any substantial changes to strucmre are anticipated, please contact a Cip� of Saint Paul Plan Examiner at 266-9007 to apph for building pemuis. If thae are any changes to the parking lot, floor space, or for new operations, please contact a City of Saim Paul Zoning Inspector at 266-9008. All applications requim the following documents. Please attach these documents w�hen submitting your application: I. A detailed description of the desigq ]ocation 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 I 1" 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 all pertinent features of the interior of the licensed facility such as seabng areas, kitchens, offices, repair 2rea, parking, rest rootns, etc. - If a request is for an addition or expansion of the licensed faciliry, indicate 6oth the cucrent azea and the proposed expansion. 2. A copy of your lease ageement or proaf of ow�nenhip of the property. SPECIFIC LICENSE APPLICATIONS REQUII2E ADATTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII,S >>>> �, zn sis� � Council File f 7 �� Ordinance # Green Sheet # 50253 1 2 3 4 5 b 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ,_ � , ,� _ , . Presented By � Referred To CITY MINNESOTA Com[nittee: Date 3q RESOLVED: That application, ID #24244, for a Parking Lot/Ramp License by J. M. ICeefe Co. DBA Reefe Company Parking, (Donald Reefe, Jr., Presideat), at 137 Robert Street South. be and the same is hereby approved. Requested by Department of: Office of License Inapections and Envirorimenta7 Protection $Y: � � �'�?'G.6 Form Approved by City Att ne //' i � Adopted by Council: Date �y �., \�, . �,`�5�'1 By: �, !hq � �.: n �— ""7 Adoption Certified by Council Secretary Approved by Mayor for Submission to � Council By: cl- . � Bys Approved by Mayor: Date _ , � �2L�`t4' By: .� ( i N°_ 50253 g � - �3�� DEPA(iiMEN7AFFlCE/CWNGL DATE INITIATED LIEP GREEN SHEE CONTACT PERSON 8 PHONE MITIRVDATE INITIALlDATE QOEPARTMENTpIRECTOF �CINCOUNdL ChristiAe A. Rozek - 266-9108 ASSIGN aCITYATTORNEV �C�TYCLERK MUST BE ON CAUNCIL AGENDA BY (OATE) NUMBER i0i1 O BUDGET OIflECTOR � FIN. & MGT. SERVICES OIP. NOUTiNG Hearing: ��( Z�j'� OFOEfl Q MAVOR (OR ASSISTPNT� O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) � ACTION HEQUESTED: J. M. Reefe Co. DBA Reefe Company Parking requests Council approval of their application for a Parking Lot/Ramp License, (Donald Keefe,'Jr., President), ID 4F24244, at 137 Robert Street South.. RECAMMENDASiOnS: npp�ova (A) m fleject (A) pERSONAL SERVICE CONTqACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ GIVIL SERVICE COMMISSION �� Has thi5 per50n/fifin ev¢r wori(ed under a cont2ct fOr this Oepartment? _ p6 COMMITfEE _ YES NO _ STAFf 2. Has this person/firm eve� been a ciry employee? — YES NO _ DiSiRiCi COUai _ 3. Does this person/firm pOSSess a skill not normally possessed by any current city employee? SUPPORTS WMCH COUNCIL 0H3ECTIVE'+ YES NO EXplain ell yes ensWers on aeperete eheet entl eHach to green sheet INITIAiING PflOBLEM. ISSUE. OPPORTVNITY (Who. WheA, When. Where. Why)' AWANTAGESIFAPPROVEO: Co�W� ,��t� �star �� i , 1997 DISADVANTAGE$ IF APPROVED' DISADVANTAGES IF NOT APPROVED. TOTAL AMOUNT OFTRANSACTION $ COST/REVENUE BUDGE7ED (CIRCLE ONE) VES NO FUNDIWG SOURCE ACTIVITV NUMBER FINANCtAt INFOAHiAT10N (EXPIAIN) g � -���� � � CLASS III LICENSE APPLICATION THIS APPLICATION IS SUBJECT TO REVIEW BY THHEE PUBLIC CTTY OF SAIi�T PALZ Office of License, Iar��.ions and Environmmtzl Pro:ection 35J St Pctc St Stite 30J S£.^v?mlBS'v��ota 531� (63R)1669Mr0 fyeC61])i6S�1]4 PLEASE TYPE OR PRINT IN INK Type of License(s} being applied fo� �L-f'J�.� ��� � g 3(�� Company Name: t� ,�� Y E� / sole Avpriaonh;p If business is incorporated, give date of incorporation: � � y 7�' Doing Business As: � 2.2 -e_ Ge . (,✓�� �!2 (� � �: k c; (!' .s�'� ` 0 97J� r � Business Phone: Business Address: ��/ �. � a 6 e.r T S � .5� �d� l ,M ..1 � Strret Address . CiTy � State Zip Between what cross streets is the bvsiness located? - �e �e � T v�r� �ai r!t � te f � �ch side of the street? W e� � Are the premises now occupied7 /� c What Type of Business? P� ✓Z �+� 9 L e� Mail To Address: y y/ a �a �a rl2 � S �...t nf �CY.n a�t /�L. �..y SS ��/ � S�n naa��„ c;ry s� Zsp Applicant Information: V NameandTifle: YIQ��' ��jt_ Ke��-c_. �� lP��S F� �aai� ��a�> � ra� Home Address: y y� d �d � a r!2 ! S ��1 .� �� y .y, � cr r�-. i•�,J SS' `/Y � StreetAddrev CitY State Zip Date of Birth: �I •� `/ �T o Place of Birth: _�j �.�� . L� y. sSa - � 9 Y 9 Home Phone: Have you ever been com�eted of any felony, crime or ��iolation of any city ordinance other than tra�c? YES NO � � Date of arrest: Charge: _ Conviction: Where? Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Mefro Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicanPs character: NAME L1St I1CCIl5CS V.'}llC}3 }'O 9.� � ?1l, Have any of the above ADDRESS currrndy hol� formerly held, or sT' . R'L � 9 9�, 5� everbeenrevoked? an interest in: �_5i �� YES nl GJw�6..5 If yes, list the dates PH023E 3�s w0.t) -�j forrevocation: i 2/78/97 Are you going to operate this business personally? Fssri \'sne �liddle Lutial NO If not, who will operate it? Home Addrs�: Stiut \eme Are you going to have a manager or assistant in this business7 please complete the foi3oning information: F�t?:�_ HomeAddicss: Stxcetlh�e CiTy Please Iis[ gour employment history for the pre��ious five (5) } ear period: Business/Emplovment Address ��es ��e.� i - J.�. keE�--�. G� � Da�e of Birth M� Zip Pnone \�umSer If the manager is not the same as the ope=ator, � Statc List all other officers of the coiporation: OFFICER TITLE HOME HOME BUSINESS DATE OF � NAME (Office Held) ADDRESS PHONE PHONE BIF2TH ��1� J�C�e�-�.-(/.� yYra 1Pd/�uzt5 L,.� s5a->9y9 s�>-�9�5� 5'�v��/ If business is a partnership, please include the following information for each partner (use additional pages if necessary): F;rn �� Home Address: Strcet Neme FvstN�e Hame Addrev: Strcc[ Name City CiTy Las[ State Zip I.ast Smte 7zp Da;e of Bir3 Zip Puonc:��tmbct Date of Birt} Phon< Tum6cr Date of BinL Phone Number MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72) (Ta�c Cleazance; Issuance of Licenses), licensing authorities ue required to provide to the State oPMinnesota Commissioner of Revenue, the Mumesoca business tax identification number and tl�e social security number of each license applicant. Under the Mmnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the follow�ing regarding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Iviinnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, ihe Department of Revenue may supply this information to the Intemal Revenue Senice. Muuiesota Taz Idenlification Numbeis (Sa]es & Use Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6181). Social Securiry Number: �I �I � O° ���� Minnesota Tax ldenti5cation Number: yI ` I Z� °�� � YES _ (�leidrnj Cin _ YES vyddle v,;ti� �;a�,� (4teidcn) Midd{e Snilial q? -i.��� If a Minnesots TaY Ident�cation Number is not required for the business being operated, indicate so by placing an "X" in the box. �_; 2/18.97 �% "/�:�<o CEkTIFICA7ION OF WORKERS' CO':vtPENSATION CO VERAGE PURSUANT TO MII��TTESOTA STATUTE 176.182 I hereb}� certify that I, or mp company, azn in compliance with the �3•oc};ers' compensation 'v-vsurance corerage requiremrnts of MvZnesota S`�tute 176.182, subdi��ision 2. I also unders[and that provision of false information in this cefufication constitutes s�cient grounds for zdverse zcuon against all licenses held, including revoc2lion znd suspension of said licenses. I�Tazne of Insurance Company: Policyl�TUmber. � 3 f � (� C� (J .S e — t� � % S Q Coverage frorm �d ! 1 7 to / e ( I have no emplopees covered under workers' compensation insw-ance (T?SITIALS) ANY FALSIFICATION OF ANSWERS GNEIv OR MATERIAL SUBMIT`I'ED WILI, RESULT IN DENIELL OF THIS APPLICATION I hereby state that I have ansa�ered all of tl�e preceding questions, and that the infotmation contained herein is true and correct to the b:st of my know]edge and belief I hereby sfate further that i have received no money or other consideration by way of loan, gift, contributioa or ol�eiu�ise, other than already disciosed in the application which I herewith submittxl I also understand this premise may be inspected by pe':ice, fire, health and other ciry officials at any and all times when the business is in operation. � Signature (REQU7RED for W e will accept paJ�ment by eash, cbeck (made payable to City of Saint Paul) or credit card (M/C or Visa). �� �'/97 Dafe IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLOWINGINFORb1ATION: �MasterCud � Visa TiON DATE: � � � � ACCOUNP NIJMBER: ' � � � � � � � � � � � � � � � � of for all Date *•Nofe: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re�iew plans. If any substantial changes to strucmre are anticipated, please contact a Cip� of Saint Paul Plan Examiner at 266-9007 to apph for building pemuis. If thae are any changes to the parking lot, floor space, or for new operations, please contact a City of Saim Paul Zoning Inspector at 266-9008. All applications requim the following documents. Please attach these documents w�hen submitting your application: I. A detailed description of the desigq ]ocation 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 I 1" 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 all pertinent features of the interior of the licensed facility such as seabng areas, kitchens, offices, repair 2rea, parking, rest rootns, etc. - If a request is for an addition or expansion of the licensed faciliry, indicate 6oth the cucrent azea and the proposed expansion. 2. A copy of your lease ageement or proaf of ow�nenhip of the property. SPECIFIC LICENSE APPLICATIONS REQUII2E ADATTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII,S >>>> �, zn sis� � Council File f 7 �� Ordinance # Green Sheet # 50253 1 2 3 4 5 b 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ,_ � , ,� _ , . Presented By � Referred To CITY MINNESOTA Com[nittee: Date 3q RESOLVED: That application, ID #24244, for a Parking Lot/Ramp License by J. M. ICeefe Co. DBA Reefe Company Parking, (Donald Reefe, Jr., Presideat), at 137 Robert Street South. be and the same is hereby approved. Requested by Department of: Office of License Inapections and Envirorimenta7 Protection $Y: � � �'�?'G.6 Form Approved by City Att ne //' i � Adopted by Council: Date �y �., \�, . �,`�5�'1 By: �, !hq � �.: n �— ""7 Adoption Certified by Council Secretary Approved by Mayor for Submission to � Council By: cl- . � Bys Approved by Mayor: Date _ , � �2L�`t4' By: .� ( i N°_ 50253 g � - �3�� DEPA(iiMEN7AFFlCE/CWNGL DATE INITIATED LIEP GREEN SHEE CONTACT PERSON 8 PHONE MITIRVDATE INITIALlDATE QOEPARTMENTpIRECTOF �CINCOUNdL ChristiAe A. Rozek - 266-9108 ASSIGN aCITYATTORNEV �C�TYCLERK MUST BE ON CAUNCIL AGENDA BY (OATE) NUMBER i0i1 O BUDGET OIflECTOR � FIN. & MGT. SERVICES OIP. NOUTiNG Hearing: ��( Z�j'� OFOEfl Q MAVOR (OR ASSISTPNT� O TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) � ACTION HEQUESTED: J. M. Reefe Co. DBA Reefe Company Parking requests Council approval of their application for a Parking Lot/Ramp License, (Donald Keefe,'Jr., President), ID 4F24244, at 137 Robert Street South.. RECAMMENDASiOnS: npp�ova (A) m fleject (A) pERSONAL SERVICE CONTqACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ GIVIL SERVICE COMMISSION �� Has thi5 per50n/fifin ev¢r wori(ed under a cont2ct fOr this Oepartment? _ p6 COMMITfEE _ YES NO _ STAFf 2. Has this person/firm eve� been a ciry employee? — YES NO _ DiSiRiCi COUai _ 3. Does this person/firm pOSSess a skill not normally possessed by any current city employee? SUPPORTS WMCH COUNCIL 0H3ECTIVE'+ YES NO EXplain ell yes ensWers on aeperete eheet entl eHach to green sheet INITIAiING PflOBLEM. ISSUE. OPPORTVNITY (Who. WheA, When. Where. Why)' AWANTAGESIFAPPROVEO: Co�W� ,��t� �star �� i , 1997 DISADVANTAGE$ IF APPROVED' DISADVANTAGES IF NOT APPROVED. TOTAL AMOUNT OFTRANSACTION $ COST/REVENUE BUDGE7ED (CIRCLE ONE) VES NO FUNDIWG SOURCE ACTIVITV NUMBER FINANCtAt INFOAHiAT10N (EXPIAIN) g � -���� � � CLASS III LICENSE APPLICATION THIS APPLICATION IS SUBJECT TO REVIEW BY THHEE PUBLIC CTTY OF SAIi�T PALZ Office of License, Iar��.ions and Environmmtzl Pro:ection 35J St Pctc St Stite 30J S£.^v?mlBS'v��ota 531� (63R)1669Mr0 fyeC61])i6S�1]4 PLEASE TYPE OR PRINT IN INK Type of License(s} being applied fo� �L-f'J�.� ��� � g 3(�� Company Name: t� ,�� Y E� / sole Avpriaonh;p If business is incorporated, give date of incorporation: � � y 7�' Doing Business As: � 2.2 -e_ Ge . (,✓�� �!2 (� � �: k c; (!' .s�'� ` 0 97J� r � Business Phone: Business Address: ��/ �. � a 6 e.r T S � .5� �d� l ,M ..1 � Strret Address . CiTy � State Zip Between what cross streets is the bvsiness located? - �e �e � T v�r� �ai r!t � te f � �ch side of the street? W e� � Are the premises now occupied7 /� c What Type of Business? P� ✓Z �+� 9 L e� Mail To Address: y y/ a �a �a rl2 � S �...t nf �CY.n a�t /�L. �..y SS ��/ � S�n naa��„ c;ry s� Zsp Applicant Information: V NameandTifle: YIQ��' ��jt_ Ke��-c_. �� lP��S F� �aai� ��a�> � ra� Home Address: y y� d �d � a r!2 ! S ��1 .� �� y .y, � cr r�-. i•�,J SS' `/Y � StreetAddrev CitY State Zip Date of Birth: �I •� `/ �T o Place of Birth: _�j �.�� . L� y. sSa - � 9 Y 9 Home Phone: Have you ever been com�eted of any felony, crime or ��iolation of any city ordinance other than tra�c? YES NO � � Date of arrest: Charge: _ Conviction: Where? Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Mefro Area, not related to the applicant or financially interested in the premises or business, who may be referred to as to the applicanPs character: NAME L1St I1CCIl5CS V.'}llC}3 }'O 9.� � ?1l, Have any of the above ADDRESS currrndy hol� formerly held, or sT' . R'L � 9 9�, 5� everbeenrevoked? an interest in: �_5i �� YES nl GJw�6..5 If yes, list the dates PH023E 3�s w0.t) -�j forrevocation: i 2/78/97 Are you going to operate this business personally? Fssri \'sne �liddle Lutial NO If not, who will operate it? Home Addrs�: Stiut \eme Are you going to have a manager or assistant in this business7 please complete the foi3oning information: F�t?:�_ HomeAddicss: Stxcetlh�e CiTy Please Iis[ gour employment history for the pre��ious five (5) } ear period: Business/Emplovment Address ��es ��e.� i - J.�. keE�--�. G� � Da�e of Birth M� Zip Pnone \�umSer If the manager is not the same as the ope=ator, � Statc List all other officers of the coiporation: OFFICER TITLE HOME HOME BUSINESS DATE OF � NAME (Office Held) ADDRESS PHONE PHONE BIF2TH ��1� J�C�e�-�.-(/.� yYra 1Pd/�uzt5 L,.� s5a->9y9 s�>-�9�5� 5'�v��/ If business is a partnership, please include the following information for each partner (use additional pages if necessary): F;rn �� Home Address: Strcet Neme FvstN�e Hame Addrev: Strcc[ Name City CiTy Las[ State Zip I.ast Smte 7zp Da;e of Bir3 Zip Puonc:��tmbct Date of Birt} Phon< Tum6cr Date of BinL Phone Number MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(270.72) (Ta�c Cleazance; Issuance of Licenses), licensing authorities ue required to provide to the State oPMinnesota Commissioner of Revenue, the Mumesoca business tax identification number and tl�e social security number of each license applicant. Under the Mmnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the follow�ing regarding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Iviinnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement, ihe Department of Revenue may supply this information to the Intemal Revenue Senice. Muuiesota Taz Idenlification Numbeis (Sa]es & Use Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6181). Social Securiry Number: �I �I � O° ���� Minnesota Tax ldenti5cation Number: yI ` I Z� °�� � YES _ (�leidrnj Cin _ YES vyddle v,;ti� �;a�,� (4teidcn) Midd{e Snilial q? -i.��� If a Minnesots TaY Ident�cation Number is not required for the business being operated, indicate so by placing an "X" in the box. �_; 2/18.97 �% "/�:�<o CEkTIFICA7ION OF WORKERS' CO':vtPENSATION CO VERAGE PURSUANT TO MII��TTESOTA STATUTE 176.182 I hereb}� certify that I, or mp company, azn in compliance with the �3•oc};ers' compensation 'v-vsurance corerage requiremrnts of MvZnesota S`�tute 176.182, subdi��ision 2. I also unders[and that provision of false information in this cefufication constitutes s�cient grounds for zdverse zcuon against all licenses held, including revoc2lion znd suspension of said licenses. I�Tazne of Insurance Company: Policyl�TUmber. � 3 f � (� C� (J .S e — t� � % S Q Coverage frorm �d ! 1 7 to / e ( I have no emplopees covered under workers' compensation insw-ance (T?SITIALS) ANY FALSIFICATION OF ANSWERS GNEIv OR MATERIAL SUBMIT`I'ED WILI, RESULT IN DENIELL OF THIS APPLICATION I hereby state that I have ansa�ered all of tl�e preceding questions, and that the infotmation contained herein is true and correct to the b:st of my know]edge and belief I hereby sfate further that i have received no money or other consideration by way of loan, gift, contributioa or ol�eiu�ise, other than already disciosed in the application which I herewith submittxl I also understand this premise may be inspected by pe':ice, fire, health and other ciry officials at any and all times when the business is in operation. � Signature (REQU7RED for W e will accept paJ�ment by eash, cbeck (made payable to City of Saint Paul) or credit card (M/C or Visa). �� �'/97 Dafe IFPAYINGBYCREDITCARDPLEASECOMPLETETHEFOLLOWINGINFORb1ATION: �MasterCud � Visa TiON DATE: � � � � ACCOUNP NIJMBER: ' � � � � � � � � � � � � � � � � of for all Date *•Nofe: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re�iew plans. If any substantial changes to strucmre are anticipated, please contact a Cip� of Saint Paul Plan Examiner at 266-9007 to apph for building pemuis. If thae are any changes to the parking lot, floor space, or for new operations, please contact a City of Saim Paul Zoning Inspector at 266-9008. All applications requim the following documents. Please attach these documents w�hen submitting your application: I. A detailed description of the desigq ]ocation 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 I 1" 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 all pertinent features of the interior of the licensed facility such as seabng areas, kitchens, offices, repair 2rea, parking, rest rootns, etc. - If a request is for an addition or expansion of the licensed faciliry, indicate 6oth the cucrent azea and the proposed expansion. 2. A copy of your lease ageement or proaf of ow�nenhip of the property. SPECIFIC LICENSE APPLICATIONS REQUII2E ADATTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII,S >>>> �, zn sis� �