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97-1426Council File# �/ �� Z�p Ordinance $ RESOLUTION PAUL, MINNESOTA Presented By Referred To 1 2 3 4 5 6 3y 1. Facility will not be able to open until all trade permits are finaled and Fire Prevention has given approval. Yeas Nays Absent Requested by Department of: Blakev � Bostrom _�/' Harris .,/' . Meqard ,/ Morton �/ ' Thune �/' Collina Adopted by Council: Date '��a .2.1.. � \`�`(�, Of£ice of I.icense, Inspection Environmental Protection BY: 1.,�--1-.-�i '.c-.-v �1-(�,,.� Adoption Certified by Council Secretary Form Approved by City Att B Y� � �-1�- �.,ti.� By: � X�`��'�-�il Approved by Mayor: Date �Zl�t� r Approved by Mayor for Submission Council gp; �� - - / Committee: Date RESOLVED: That appli tc ia (ID �19970000031) for a Tanning Facility, Health/Sport Club License(s) by FCA LTD DBA LIFE TIME FITNESS at 340 CEDAR ST be the same and is hereby approved with the Pollowing conditions: By: Green Sheet $ 50297 N° 502 q7-�y� SHEET ��-�. o vn cwNCIL AGENDA BY � '� � pTVp170RNEY —�----'-- �I GITYCOUNpL �� "�' (DATE� NUMBERFOq 11/26/97 AOUTING O ❑ C � TMCLERK ORDER ❑ MAyOR (pR ASSISiAN'n --� � FIN. 8 MGi. $ERVICES DIR. 707AL # OF SIGNA7URE AqGES —� � r,,,,.,,,; i cTiONaEOOesreo � ALL �OCATIONS FOR SIGNATURE) Re�^^r �- Council approval of the following license a lication: for: FCA LTD,:'.Doing Business As: LIFE TIME FITNESS Pyt; License 9/19970000031, Facility, Health/Sport Club License(s). 340 Cedar Street for a Tanning , ECOMMENDNTIONS: AO��ve fA) or Rejea (R) — PLANNING COMMISSION � GViI _ CIBCOMMITfEE _ STAiF .__ DISTRICTCOURT SUPPpqTS WHICH CqUNpL OB,IECT�VE? Wnen. IF PERSONAL SEqVICE CONiRACTS MUST ANSWEq TNE FOLLOWING QUES710NS: L Has tryis persop/firm ever worked under a cpntract lor this departrtignt? VES NO Z. Has ihis personRirm ever been a city employ¢¢? �ES NO 3 Does this persoNfirm po�yu a skill not normally possessed by any current city employeel � YES NO Explaln all yes answers pn separate eheet and attach to green aheet ��ryai (��,� F/�� NOV l.9 1997 1L AMOUNT OF TRANSACTION $ 11WG SOURCE CIAL INFORFiqi�ON' (EXPLq�ry) COST/REVENUE BUOGETED (CIRCLE ONE) AC7IVITY NUMBER VES NO -er �AIN7 PAU(, � AAAA Type ofLicense(s) being .P._ Company Name: � CLASS III LICENSE APpLjCATION THIS AI'PLICATION IS SiJB,TE�T TO REVIEW gy � P�LIC PLEASE TYPE OR PRII�rT �r � Coryoration/PartnczxW /Sol If business is incorporated, give date of incqrpo ppn c�nhip Doing Business As: L� E 9 Business Address: � �{ �� S s�=e ndaK z " � Berit'een what cross streets is Ihe business located? =_ Are the r � P emises now occupied7 �� p �_ VJhat Type ofBusiness7 N Mail To qddress: ,� �n i, so-�tt naa.�, Applicant Inf�„ Name and TiUe: First Home Address: _ �3 5 waai� --�— D (Me�drn) i'�aG c;ry ctry v � Stre tqd� V � ,(J/ � � DateofBirth: ,�i G � city Place of Birth: Have you ever been convicted of any felony, crime or violaho�of any c'ty ordi�� o �� DateoFarrest ��q Chazge: _ ' �ere? Conviction: CITY OF SAINT � �ce of License, Inspe�� and Environmental Pro[ection 350 SC Pefa SG SLitc 3pp Sa"vi[Paul,Mumcsot¢ SSI01 (6I])266.gp9p �(61�)��9124 S � � $ � cc /� oc Eh � 3 �� °" /�r� BusinessPhone: 6�� p�7_adUo N�i �cl h ,5.�3 ��' State Z � P Which side of the strcetp So�,. �2! / /o/ sr�� Z � P p c� La+t TiUe � iv s".t'Y��' Stste Zip Home Phone: �e f � � ? � NO List the names and residences of three Sentence: or financially interested in the premises or�bu �n �� ho may be refetred o as to the applicanYs character: T U wiihin the Twin Cities Metro qre$ not related to the applicant NAIv1E � ADDRESS �� L �� /� F PHONE �FT'� �F{/ � 6 � � �S"/b .ST�vE u u e�2 T �� "/�-a3 .ist licenses which you currently hold, formerly held or may have an interest in: . S3 �'�3�� 'A�T7� �SPertr C..�„d �ave an of '��G +�A-� / Y ihe above named hcenses ever been revokedT Y�S NO Ifyes, list the dates and reasons for revocation: 2/18/97 � Are,pou going to operate this business personally? YES � NO If not, who will operate it? 97-/y2 G. � FuxtName Middlclnitial (Meidrn) I.ast DateefS' /.1,3 0 � - �3 �` � ST �?P LS /yJ /�� S 7 Home dresa: StrretNemc City State 2ip PhoncNum6er Are you going to have a manager or assistant in trus business? � YES please complete the following infonnauon: �_ !J l; �� FTf� IY! �/.( h`�/+ Fi�,r namc Midd(e Ini[ia! NO ff the manager Ss not the same as the operator, � , .t llalc ofBirth Homc.4ddress: StrectNemc City Stete Zip PhoneNumbcr Please list your employment history for the previous five (S) year period: BusinesslEmplovment jp { I (' A�� r�- L� !�S 7��a� ur �., a6,w�s 7ZT'' TI�¢ List alI other officers of the cozporation: OFFICER TITLE � / NAME V (�, . t � (Office Held) HOME ADDRESS HOME aun� BUSINESS punn� DATE OF pa rme�rshi�, please include the following information for each partner (use additianal pages if necessary): Home Addrese: Strect Namc Stam Zig Fu1t NvnC M3ddlc Initiei (Meidm) SVCet Neme City State Dutc of Birih MIDINESOTA TAX IDLNTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(2�0.72) (Ta�c Clearance; Issuance of Licenses), ]icensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Ivlinnesota business tax identification number and the social security number of each license applicant. Under the Minnesota Government Data Practices Act and the Pederal Privacy Act of 1974, we aze required to advise you of the following regarding the use of the Minnesota Tax Idenfification Number: - This inforrnation may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withhoiding or motor vehicle excise taxes; - Upon receiving this informa[ion, the licensing authority will supply it only m the Minnesota Departrnent of Revenue. However, under the Federal Lxchange of Tnfoanation Agreement, the Department of Revenue may supply this information to �iie Intemal Revenue Servicc. Minnesota TaY Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Mumesota, Business Records Depar[ment, 10 River Pazk Plaza (612-296-6181). ��era}�'s c�� rrber: ��'' d g 7�b Minnesota Tax Identification Number: J!�! 7/ b If a Minnesota 1':+x Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. 2/18/97 r¢s� name [vuaa�e wt�ai (Msiden) Last ,� llatc of Birth � AAAA TANNINC',- FACILITY LICENSE APPLICATION 4 * i. ApplicantlCompany Name: �� ti �-"� . Business Name: ��a. t_ �FG T r�� F�-rN s Business Phone: �j?-} �t �7 - r� c��n Business Address: 3�n �xda,� ��. .5�, � r,�, ,� N ,�3'fo 1 Ivlail To Address. �tF'F.L C�-i t�er� ,(`�..�v #37� f�e,� �✓'4'r � � hl .�3 `f� �!F � �� (if d38'etent than above) � ' OwnerlManagerName: F %yf s-t�,� Home Address: �.�� o�. �f3 �'� /�2 /�jP� Home P Portions ofthe building to be used as a tanning facility: �/bow,S r+� 7`� 41c9,..a.�s �cKc� r�,,, s. Is your tanning facility operated in conjunction with another business? Yes If yes, what type of business? �� / Please provide the followin� information Manufacturer's Name S kN of Applicant each iece o£tann Model Number Su�+.D�ksk CITY OF SA PA oe;ce af Ltcease, tnspu,�tio,u and Environmentat Arotection asos.e�as�awo;scr,w,� ssim (612)1659100 - faY (611)�654114 L��e m� (for office ¢c-, on]y) No in your licensed business: I'ear Number in M2Tlllfachli@d Establishment Type (Booth, Bed, CanoPY Etc J �� 7 D e �,�,�.anoisl Council File# �/ �� Z�p Ordinance $ RESOLUTION PAUL, MINNESOTA Presented By Referred To 1 2 3 4 5 6 3y 1. Facility will not be able to open until all trade permits are finaled and Fire Prevention has given approval. Yeas Nays Absent Requested by Department of: Blakev � Bostrom _�/' Harris .,/' . Meqard ,/ Morton �/ ' Thune �/' Collina Adopted by Council: Date '��a .2.1.. � \`�`(�, Of£ice of I.icense, Inspection Environmental Protection BY: 1.,�--1-.-�i '.c-.-v �1-(�,,.� Adoption Certified by Council Secretary Form Approved by City Att B Y� � �-1�- �.,ti.� By: � X�`��'�-�il Approved by Mayor: Date �Zl�t� r Approved by Mayor for Submission Council gp; �� - - / Committee: Date RESOLVED: That appli tc ia (ID �19970000031) for a Tanning Facility, Health/Sport Club License(s) by FCA LTD DBA LIFE TIME FITNESS at 340 CEDAR ST be the same and is hereby approved with the Pollowing conditions: By: Green Sheet $ 50297 N° 502 q7-�y� SHEET ��-�. o vn cwNCIL AGENDA BY � '� � pTVp170RNEY —�----'-- �I GITYCOUNpL �� "�' (DATE� NUMBERFOq 11/26/97 AOUTING O ❑ C � TMCLERK ORDER ❑ MAyOR (pR ASSISiAN'n --� � FIN. 8 MGi. $ERVICES DIR. 707AL # OF SIGNA7URE AqGES —� � r,,,,.,,,; i cTiONaEOOesreo � ALL �OCATIONS FOR SIGNATURE) Re�^^r �- Council approval of the following license a lication: for: FCA LTD,:'.Doing Business As: LIFE TIME FITNESS Pyt; License 9/19970000031, Facility, Health/Sport Club License(s). 340 Cedar Street for a Tanning , ECOMMENDNTIONS: AO��ve fA) or Rejea (R) — PLANNING COMMISSION � GViI _ CIBCOMMITfEE _ STAiF .__ DISTRICTCOURT SUPPpqTS WHICH CqUNpL OB,IECT�VE? Wnen. IF PERSONAL SEqVICE CONiRACTS MUST ANSWEq TNE FOLLOWING QUES710NS: L Has tryis persop/firm ever worked under a cpntract lor this departrtignt? VES NO Z. Has ihis personRirm ever been a city employ¢¢? �ES NO 3 Does this persoNfirm po�yu a skill not normally possessed by any current city employeel � YES NO Explaln all yes answers pn separate eheet and attach to green aheet ��ryai (��,� F/�� NOV l.9 1997 1L AMOUNT OF TRANSACTION $ 11WG SOURCE CIAL INFORFiqi�ON' (EXPLq�ry) COST/REVENUE BUOGETED (CIRCLE ONE) AC7IVITY NUMBER VES NO -er �AIN7 PAU(, � AAAA Type ofLicense(s) being .P._ Company Name: � CLASS III LICENSE APpLjCATION THIS AI'PLICATION IS SiJB,TE�T TO REVIEW gy � P�LIC PLEASE TYPE OR PRII�rT �r � Coryoration/PartnczxW /Sol If business is incorporated, give date of incqrpo ppn c�nhip Doing Business As: L� E 9 Business Address: � �{ �� S s�=e ndaK z " � Berit'een what cross streets is Ihe business located? =_ Are the r � P emises now occupied7 �� p �_ VJhat Type ofBusiness7 N Mail To qddress: ,� �n i, so-�tt naa.�, Applicant Inf�„ Name and TiUe: First Home Address: _ �3 5 waai� --�— D (Me�drn) i'�aG c;ry ctry v � Stre tqd� V � ,(J/ � � DateofBirth: ,�i G � city Place of Birth: Have you ever been convicted of any felony, crime or violaho�of any c'ty ordi�� o �� DateoFarrest ��q Chazge: _ ' �ere? Conviction: CITY OF SAINT � �ce of License, Inspe�� and Environmental Pro[ection 350 SC Pefa SG SLitc 3pp Sa"vi[Paul,Mumcsot¢ SSI01 (6I])266.gp9p �(61�)��9124 S � � $ � cc /� oc Eh � 3 �� °" /�r� BusinessPhone: 6�� p�7_adUo N�i �cl h ,5.�3 ��' State Z � P Which side of the strcetp So�,. �2! / /o/ sr�� Z � P p c� La+t TiUe � iv s".t'Y��' Stste Zip Home Phone: �e f � � ? � NO List the names and residences of three Sentence: or financially interested in the premises or�bu �n �� ho may be refetred o as to the applicanYs character: T U wiihin the Twin Cities Metro qre$ not related to the applicant NAIv1E � ADDRESS �� L �� /� F PHONE �FT'� �F{/ � 6 � � �S"/b .ST�vE u u e�2 T �� "/�-a3 .ist licenses which you currently hold, formerly held or may have an interest in: . S3 �'�3�� 'A�T7� �SPertr C..�„d �ave an of '��G +�A-� / Y ihe above named hcenses ever been revokedT Y�S NO Ifyes, list the dates and reasons for revocation: 2/18/97 � Are,pou going to operate this business personally? YES � NO If not, who will operate it? 97-/y2 G. � FuxtName Middlclnitial (Meidrn) I.ast DateefS' /.1,3 0 � - �3 �` � ST �?P LS /yJ /�� S 7 Home dresa: StrretNemc City State 2ip PhoncNum6er Are you going to have a manager or assistant in trus business? � YES please complete the following infonnauon: �_ !J l; �� FTf� IY! �/.( h`�/+ Fi�,r namc Midd(e Ini[ia! NO ff the manager Ss not the same as the operator, � , .t llalc ofBirth Homc.4ddress: StrectNemc City Stete Zip PhoneNumbcr Please list your employment history for the previous five (S) year period: BusinesslEmplovment jp { I (' A�� r�- L� !�S 7��a� ur �., a6,w�s 7ZT'' TI�¢ List alI other officers of the cozporation: OFFICER TITLE � / NAME V (�, . t � (Office Held) HOME ADDRESS HOME aun� BUSINESS punn� DATE OF pa rme�rshi�, please include the following information for each partner (use additianal pages if necessary): Home Addrese: Strect Namc Stam Zig Fu1t NvnC M3ddlc Initiei (Meidm) SVCet Neme City State Dutc of Birih MIDINESOTA TAX IDLNTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(2�0.72) (Ta�c Clearance; Issuance of Licenses), ]icensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Ivlinnesota business tax identification number and the social security number of each license applicant. Under the Minnesota Government Data Practices Act and the Pederal Privacy Act of 1974, we aze required to advise you of the following regarding the use of the Minnesota Tax Idenfification Number: - This inforrnation may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withhoiding or motor vehicle excise taxes; - Upon receiving this informa[ion, the licensing authority will supply it only m the Minnesota Departrnent of Revenue. However, under the Federal Lxchange of Tnfoanation Agreement, the Department of Revenue may supply this information to �iie Intemal Revenue Servicc. Minnesota TaY Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Mumesota, Business Records Depar[ment, 10 River Pazk Plaza (612-296-6181). ��era}�'s c�� rrber: ��'' d g 7�b Minnesota Tax Identification Number: J!�! 7/ b If a Minnesota 1':+x Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. 2/18/97 r¢s� name [vuaa�e wt�ai (Msiden) Last ,� llatc of Birth � AAAA TANNINC',- FACILITY LICENSE APPLICATION 4 * i. ApplicantlCompany Name: �� ti �-"� . Business Name: ��a. t_ �FG T r�� F�-rN s Business Phone: �j?-} �t �7 - r� c��n Business Address: 3�n �xda,� ��. .5�, � r,�, ,� N ,�3'fo 1 Ivlail To Address. �tF'F.L C�-i t�er� ,(`�..�v #37� f�e,� �✓'4'r � � hl .�3 `f� �!F � �� (if d38'etent than above) � ' OwnerlManagerName: F %yf s-t�,� Home Address: �.�� o�. �f3 �'� /�2 /�jP� Home P Portions ofthe building to be used as a tanning facility: �/bow,S r+� 7`� 41c9,..a.�s �cKc� r�,,, s. Is your tanning facility operated in conjunction with another business? Yes If yes, what type of business? �� / Please provide the followin� information Manufacturer's Name S kN of Applicant each iece o£tann Model Number Su�+.D�ksk CITY OF SA PA oe;ce af Ltcease, tnspu,�tio,u and Environmentat Arotection asos.e�as�awo;scr,w,� ssim (612)1659100 - faY (611)�654114 L��e m� (for office ¢c-, on]y) No in your licensed business: I'ear Number in M2Tlllfachli@d Establishment Type (Booth, Bed, CanoPY Etc J �� 7 D e �,�,�.anoisl Council File# �/ �� Z�p Ordinance $ RESOLUTION PAUL, MINNESOTA Presented By Referred To 1 2 3 4 5 6 3y 1. Facility will not be able to open until all trade permits are finaled and Fire Prevention has given approval. Yeas Nays Absent Requested by Department of: Blakev � Bostrom _�/' Harris .,/' . Meqard ,/ Morton �/ ' Thune �/' Collina Adopted by Council: Date '��a .2.1.. � \`�`(�, Of£ice of I.icense, Inspection Environmental Protection BY: 1.,�--1-.-�i '.c-.-v �1-(�,,.� Adoption Certified by Council Secretary Form Approved by City Att B Y� � �-1�- �.,ti.� By: � X�`��'�-�il Approved by Mayor: Date �Zl�t� r Approved by Mayor for Submission Council gp; �� - - / Committee: Date RESOLVED: That appli tc ia (ID �19970000031) for a Tanning Facility, Health/Sport Club License(s) by FCA LTD DBA LIFE TIME FITNESS at 340 CEDAR ST be the same and is hereby approved with the Pollowing conditions: By: Green Sheet $ 50297 N° 502 q7-�y� SHEET ��-�. o vn cwNCIL AGENDA BY � '� � pTVp170RNEY —�----'-- �I GITYCOUNpL �� "�' (DATE� NUMBERFOq 11/26/97 AOUTING O ❑ C � TMCLERK ORDER ❑ MAyOR (pR ASSISiAN'n --� � FIN. 8 MGi. $ERVICES DIR. 707AL # OF SIGNA7URE AqGES —� � r,,,,.,,,; i cTiONaEOOesreo � ALL �OCATIONS FOR SIGNATURE) Re�^^r �- Council approval of the following license a lication: for: FCA LTD,:'.Doing Business As: LIFE TIME FITNESS Pyt; License 9/19970000031, Facility, Health/Sport Club License(s). 340 Cedar Street for a Tanning , ECOMMENDNTIONS: AO��ve fA) or Rejea (R) — PLANNING COMMISSION � GViI _ CIBCOMMITfEE _ STAiF .__ DISTRICTCOURT SUPPpqTS WHICH CqUNpL OB,IECT�VE? Wnen. IF PERSONAL SEqVICE CONiRACTS MUST ANSWEq TNE FOLLOWING QUES710NS: L Has tryis persop/firm ever worked under a cpntract lor this departrtignt? VES NO Z. Has ihis personRirm ever been a city employ¢¢? �ES NO 3 Does this persoNfirm po�yu a skill not normally possessed by any current city employeel � YES NO Explaln all yes answers pn separate eheet and attach to green aheet ��ryai (��,� F/�� NOV l.9 1997 1L AMOUNT OF TRANSACTION $ 11WG SOURCE CIAL INFORFiqi�ON' (EXPLq�ry) COST/REVENUE BUOGETED (CIRCLE ONE) AC7IVITY NUMBER VES NO -er �AIN7 PAU(, � AAAA Type ofLicense(s) being .P._ Company Name: � CLASS III LICENSE APpLjCATION THIS AI'PLICATION IS SiJB,TE�T TO REVIEW gy � P�LIC PLEASE TYPE OR PRII�rT �r � Coryoration/PartnczxW /Sol If business is incorporated, give date of incqrpo ppn c�nhip Doing Business As: L� E 9 Business Address: � �{ �� S s�=e ndaK z " � Berit'een what cross streets is Ihe business located? =_ Are the r � P emises now occupied7 �� p �_ VJhat Type ofBusiness7 N Mail To qddress: ,� �n i, so-�tt naa.�, Applicant Inf�„ Name and TiUe: First Home Address: _ �3 5 waai� --�— D (Me�drn) i'�aG c;ry ctry v � Stre tqd� V � ,(J/ � � DateofBirth: ,�i G � city Place of Birth: Have you ever been convicted of any felony, crime or violaho�of any c'ty ordi�� o �� DateoFarrest ��q Chazge: _ ' �ere? Conviction: CITY OF SAINT � �ce of License, Inspe�� and Environmental Pro[ection 350 SC Pefa SG SLitc 3pp Sa"vi[Paul,Mumcsot¢ SSI01 (6I])266.gp9p �(61�)��9124 S � � $ � cc /� oc Eh � 3 �� °" /�r� BusinessPhone: 6�� p�7_adUo N�i �cl h ,5.�3 ��' State Z � P Which side of the strcetp So�,. �2! / /o/ sr�� Z � P p c� La+t TiUe � iv s".t'Y��' Stste Zip Home Phone: �e f � � ? � NO List the names and residences of three Sentence: or financially interested in the premises or�bu �n �� ho may be refetred o as to the applicanYs character: T U wiihin the Twin Cities Metro qre$ not related to the applicant NAIv1E � ADDRESS �� L �� /� F PHONE �FT'� �F{/ � 6 � � �S"/b .ST�vE u u e�2 T �� "/�-a3 .ist licenses which you currently hold, formerly held or may have an interest in: . S3 �'�3�� 'A�T7� �SPertr C..�„d �ave an of '��G +�A-� / Y ihe above named hcenses ever been revokedT Y�S NO Ifyes, list the dates and reasons for revocation: 2/18/97 � Are,pou going to operate this business personally? YES � NO If not, who will operate it? 97-/y2 G. � FuxtName Middlclnitial (Meidrn) I.ast DateefS' /.1,3 0 � - �3 �` � ST �?P LS /yJ /�� S 7 Home dresa: StrretNemc City State 2ip PhoncNum6er Are you going to have a manager or assistant in trus business? � YES please complete the following infonnauon: �_ !J l; �� FTf� IY! �/.( h`�/+ Fi�,r namc Midd(e Ini[ia! NO ff the manager Ss not the same as the operator, � , .t llalc ofBirth Homc.4ddress: StrectNemc City Stete Zip PhoneNumbcr Please list your employment history for the previous five (S) year period: BusinesslEmplovment jp { I (' A�� r�- L� !�S 7��a� ur �., a6,w�s 7ZT'' TI�¢ List alI other officers of the cozporation: OFFICER TITLE � / NAME V (�, . t � (Office Held) HOME ADDRESS HOME aun� BUSINESS punn� DATE OF pa rme�rshi�, please include the following information for each partner (use additianal pages if necessary): Home Addrese: Strect Namc Stam Zig Fu1t NvnC M3ddlc Initiei (Meidm) SVCet Neme City State Dutc of Birih MIDINESOTA TAX IDLNTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2(2�0.72) (Ta�c Clearance; Issuance of Licenses), ]icensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Ivlinnesota business tax identification number and the social security number of each license applicant. Under the Minnesota Government Data Practices Act and the Pederal Privacy Act of 1974, we aze required to advise you of the following regarding the use of the Minnesota Tax Idenfification Number: - This inforrnation may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withhoiding or motor vehicle excise taxes; - Upon receiving this informa[ion, the licensing authority will supply it only m the Minnesota Departrnent of Revenue. However, under the Federal Lxchange of Tnfoanation Agreement, the Department of Revenue may supply this information to �iie Intemal Revenue Servicc. Minnesota TaY Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Mumesota, Business Records Depar[ment, 10 River Pazk Plaza (612-296-6181). ��era}�'s c�� rrber: ��'' d g 7�b Minnesota Tax Identification Number: J!�! 7/ b If a Minnesota 1':+x Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. 2/18/97 r¢s� name [vuaa�e wt�ai (Msiden) Last ,� llatc of Birth � AAAA TANNINC',- FACILITY LICENSE APPLICATION 4 * i. ApplicantlCompany Name: �� ti �-"� . Business Name: ��a. t_ �FG T r�� F�-rN s Business Phone: �j?-} �t �7 - r� c��n Business Address: 3�n �xda,� ��. .5�, � r,�, ,� N ,�3'fo 1 Ivlail To Address. �tF'F.L C�-i t�er� ,(`�..�v #37� f�e,� �✓'4'r � � hl .�3 `f� �!F � �� (if d38'etent than above) � ' OwnerlManagerName: F %yf s-t�,� Home Address: �.�� o�. �f3 �'� /�2 /�jP� Home P Portions ofthe building to be used as a tanning facility: �/bow,S r+� 7`� 41c9,..a.�s �cKc� r�,,, s. Is your tanning facility operated in conjunction with another business? Yes If yes, what type of business? �� / Please provide the followin� information Manufacturer's Name S kN of Applicant each iece o£tann Model Number Su�+.D�ksk CITY OF SA PA oe;ce af Ltcease, tnspu,�tio,u and Environmentat Arotection asos.e�as�awo;scr,w,� ssim (612)1659100 - faY (611)�654114 L��e m� (for office ¢c-, on]y) No in your licensed business: I'ear Number in M2Tlllfachli@d Establishment Type (Booth, Bed, CanoPY Etc J �� 7 D e �,�,�.anoisl