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97-148��`°I� � , �tt�`-: :�, Council File # 1� � �� ordinance � Green Sheet $ �� SAINT MINNESOTA ! / Presented By Referred To Committee: Date i RESOLVED: That application (ID #18491) for an On Sale Malt (3.2) and Restaurant-B License by z Megusta Mexican C�isine Inc. DBA Megusta Mexican Restaurant (Modesto Reyes, s President) at 433 Robert Street South be and the same is hereby approved. 4 5 6 Yeas Nays Absent 7 B ak� � 9 r Ha r zs M � g � 10 � Me a � I1 Re tt man �/' 12 Thune 13 Bostrom � 15 6 C� 16 Adopted by Council: Date ��,\a, � l�{ 17 18 Adoption Certified by Council Secretary 19 20 {'� 21 BY. �---� � . F�� 22 —�- j 23 Approved by Mayor: Date 2//4 ��7- 24 �//� 25 c 26 By: �- 27 Requested hy Department of: Office of License Inspections and Environmental Protection By: �1 �"7'�%+�- - - - Form Approved by City Attorney By: / � Approved by Mayor for Submission to Council By: q�_►y�r OEPARTMENT/OFFICf./GOUNCIL DpiE�NR1ATED GREEN SHEE N� 35383` LIEPjLicensing -- -- CO ACf PERSON d PHONE O pEPARTMENT DIRECTOR mpwA O CIN COUNGL � Au�� CT'ATfOHNEY CT'CLERK Christine Rozek, 266-9108 xureexwe MUST BE ON COUNCIL AGENDA BY (DATE) R�� O BUDGEf DIRECTO � FlN. & MGT. SEHVK.ES DIR. For hearin : � � OBUEq 0 �� 0 TOTAL # OF SIGtiATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REWESiED: Megusta Mexican Cuisine INc. DBA Megusta Mexican Restaurant requests Council approval of its application £or an On Sale Malt (3.2) and Restaurant-B License located at 433 Robert Street South (ID �P18491). AECOMMENDATONS: ApWOVe (A) ar Heject (R) pERSONAI SERtlICE CONSRACTS MUST ANSWER 7HE FOLLOWING �UESTIONS: _ PIANNING C�MMISSION _ GVII SERVICE COlnM�SSiON �- Has tliis perwNF7rm ever worked under a cOntract for ihis departmerrt? - _ CIB COMMITTEE YES NO _ STp�F ` 2. Has this perso�rm ever been a ciry employee2 — YES NO — a��T �� — 3. Does this persoMirm possess a skill not normaYry possessed by arry curtent city emplqree? SUPPOFiiSWHICHCWNCILOBJECTIVE? YES NO Explefn all yes answecs on separate sheet end ettach to green sheet INITIATING PROBLEM, ISSUE, OPPf.1NTUNITY (Who, Whet, When. Whera, Why�: � R�C��'�� N4V 3 5 M�96 C��Y AT��'� ADVANTAC+ESIFAPPROVED: - DISADVANiAGES 4f APPROVE�: �{Vm9kt°`as� F's'�a�?.'�?°^�4E. k;H�'�`YdYb � � �5�+� �^–"°�� _r DISADVANTAGESIFNOTAPPflOVED: . . " TOTAL AMOUNT OF TRANSAC710N S COST/REVENUE BUD6E7E0 (CIRCLE ONE) YES NO EUNOING SOURCE ACTIVlTY NUMBER FINANCIAL INfORMATION. (EXPLAIN) Greensheet �t 35383 L.I.E.P. REVIEW CHECKLIST Date: 11/7196 �/ `� `1-1t-1 � In Tracker? I 9 app�n Recerved / npp�n arocessea LicenselD # 18491 License Type: �n Sale Malt (3.2) and Restaurant-B Company Name: Megusta Mexican Cuisine Inc. DBA: Me¢usta Mexican Restaurant Business Addresss: 433 Robert St S Bus+ness Phone: 227-3533 Contact NamejAddress: Modesto Reves, 103 Blake Road N Home Phone: 938-5337 Hop ins, 5343 Date to Council Research: I �, / Public Hearing Date:� � Q� Labels Ordered: �`/ Notice Sent to Appiicant: District Council #: � ��ll�6ll�.l,f Notice Sent to City Attomey Date inspections • l t`� Environmental Heaith 2 • 2D•Rlo I D,� . Fire License Police Zoning �2- 10'q(o Ward Comments � � 1 (1 ,� Siu Pian Aeceived� (,�j.�n �,,,� bi.[,L.y�t,ca,�j_.�p . Lease Received: '— il {I �� .G�-�-, � �- _ .�, a, .��.,� t> .� - e _ :� , j �1I -- �,�� Type of License(s) being applied for: � Compaoy;:as�: PLEASE'I'YPE OR PRL'��i' L'� L\K / Panne�ship / Sole Proprieiontup If business is incorpc Doing Business .As: Business Addrzss: _ Between what cross streetr is rhe business located? 1`��bLr 1'�t-. �+^o� Are the premises now occupied? .�2�� V�'l�at Type of Business? _ '�fail To Address: `/ 5 5 5 0. K-m a� Str�t Address Applicant Infor�paa on�: '�azne aud T±t��. Y (Y � �eS �Q � First n Tliddle Ho� Addre�.: n Ciry Iast N _ _�� _�_ Zip , w�d s, d� sneet? �dR�beri-S{_ � /�� d J S�(?�' S:2te Zip �/�PS'� ��rn,T Title S �r3 Scr�� Addras v V Ciry � S�te � , Z r ip Dat� ot Bir[h: ,_ Q�� S� Place of Birda: � xU (�� Bf� f�t' Phone: G�� -? � Have yo� �ver �zen convict:,d of any felony, cri� or viol�°.ion of any city ordinance other than trafFic? YES _�i0,� Date of � � .;sc Chaz�e: _ Cooviction• Sentence: �ist the name� and reside_-�;: wf ihree r�egsons of good racral chazacter, living w•ithin the Twin Cities Metto Area, not related to the applicant or fmancially ir�<;; ��r�a in efie premises or business, ��bo may be refesed to as to the applicant`s c6aracter: CLASS III CITY OF SAL\'T PAUL �1Cl.tV.7L 1 � OfficeofticenSe,I[L�tians 2�d Em�wnmen:at ?ntecuon :�'1SC PcaA Suec 3DJ s+tmn��sro�s�s ss�c� (612)166� ?i?4 y,��`��' �r�� -I `-t�' THIS APPLICATIO'�T IS SL TO REVIEW BY TI� PL'BLIC 4z�ere? ADDRES� -�;�,�. ".�r PHOh'E li ��e^1✓ine� ��o�P �� 1i2 �2" So �P,,�S M�.1 �i�.�C1�3,��61L�305 4��id 6 List licenses whic6 yoL cirre��iy fao7d, fo_*�.w; iy held, c�2y ha an in4e in. /�; .� � c� '( � ct S'�P` b�G De �e r W�� Li Gt,°K� �° !✓t ( � l.�e. G f�` r Have any of the above named �censes eeer E�cen revoked? _ a£S �TO If yes, list the dates aud reas� s for rev�ation: Are you goina �� oper�ee sfiis-buszaess �rs; :��"7? �_ i'FS �� n . s�'� ��,s -�.gFq :z�'s'� oper�2� it? First tna.*,^ Middse In'su� ;2.1air_";,te' liS<. Home Addr,�ss: ��,[ A.arr� ' _ _ _ . � � �� .___. .—�., SeaBc Which side of tbe �L'au of Binh .... . , , -� r�scce h:!nSu StteetAddrest �.ny � State t�re }ou gomc to na� e a manager or as<ytant m uvs busioess.' zta � �v u u�e managez �s nui �nc �u,X � u,� �E;,a��,by,,�a,� complete tiie follow•ing infocmation: �� ' _ g� - i�� Fnt�� i�a;��m;a� t+iva�,,, t<« m,�oss;nh Home Addras: S¢ea �zme Cip� Suie Zip List all other officen of tbe corporation: O�ICER TII'LE HOA� ':vA'v1E (Office Held) � ADDRE; HOME PHO\'E BliSI!�'PSS PHO\� r L) �2�- If business is a parmeiship, piease ine3ude t6e follow=ine informauon for each parmer (use addivonal paaes if nezessary�): Fvsc?:azne !.liddle Inival Home Ad&ess: Strea?:ame Fi7st Rame 1.4iddie In"rtia! (Maiden) City (:.Saiden) tast Su�e Zip Last D ATE QF BIl2TH Ola 1(SI t Date of Birth Due Home Address: Sueee ha� City S�ate Zip PLone Numbu ML'�°t�'ESOTA TAX IDET."dTEICATIOti i�'U�NIDER - Pursuant to the Laws of Nfinnesota, 1984, C1�apter 502, Anide S, Section 2(270.72} (Taz =Pearaece; Lssuaace ar tacensesJ, licenssr�� ;��orities are cequired tc> pro��ide co the State of Minnesota Commissioner of Revenue, rbe ;-;i:nesota �Susinass eax gden��icavo� nu�er u,� tf�e soclal securiry nnmber of each license applicanc - 'ni =. °_'e Y�.=•� s:�a : �„a: _ �ai �'�c:.,-, ;; za:� tge Fe?�r ivacy Act oa :9'J4, we are required to advise you of the follow�ing regarcfing the �se ��'+�e at�;�u�s�: a Tae idenafi�a�o� I'aTUmhe;: - This x..�e;, ��axic,�± �y se used tn deny ehe issuance or zesewat of you[ license in the event you owe T�tinnesota saies, emplo}�er s withholGtn� :,_ aaoEOS E�ehicle ezcise ta2es; - Upon a�ceF�ring Fi�i, ;��fom�asion, the I�censang auc�oriry utll supply it only to she Minuesota Deparm�nt of Revenue. However, und�r e� r�e�ra& �zchsnge of Infoimaeion � greeement, the Depazt�nt of Revenae may supply this information to rhe ;ntemal �L€y��.: -_a�c�. iKi�,< � s- ;c�e,��Fcaxioa A�umL�rs (�aIe� & Use Ta� k-`�m�xer; may be obtaine3 from tbe Stau of Minnesota, Business lZecoids �epac��=_; °: i�. - 'ar`xPla�° (61�-296 �'sg�� Soc;a w_.._:. =.`� i ��mber. � S' Q �l - � � � �'v..- `", ',__ , �. ,rj01]GfF�3.Ct�w� 1l t ° D � V �� . ,� _ ��. idiinnssa�, z a*. 3der,i.i.ncz:�io� i � azrzc�- as �ot s�auL�ea �'c ';r �usicess uei�g �e, indicat� ss �y g�lacing a,� "X" in the �v:... Ple,�ce list your emplo;ment history for the precious five (�) }eaz period: � - ^t°ERTIfTCATIO\ OF WORKERS' C0;�IPENSATION COV£R?.GE PliRSliA\'I' TO :�1L*ti�'ESOTA STAIUTE 176.182 I hereby certify tbat I, or my company, am in compliance with che w•orkers' comFxxasation insurance coverage requuement� of Alionesota Sumte 176.] 82, sub3ivision 2. I also understand tbat provisioa of false info�tion in this certifrcation consdmtes sufficient grounds for adcene acuon aeainst atl licenses he] mcluding re ad suspension of said licenses. ��2me of Insurance Company � Q,/' f—G 1-y �� j S�FR'T�4 f'S Polic ;��umber: � 7` �� 3 T O �e from � 4 �J to 3 D t `� � y � � � Co�'era, I b�ce no employees coeered under k�od:ers' compensation insurance - �� —�� A�\'Y FAISffICATI0:1 OF A:\S« ERS GI4'E?� OR'�1.4TERIAL SUB;��TTEB R�II,L RESULT L\ D�7AL OF THIS APPLICATIO:\T I bereby state that I have answered all of the preceding quesfions, and tf�at the informapon contained herein is true and corrut to the best of my knoa�ledge and belief. I hereby state fiuther tbat I ba��e nceived no mone � or other consideration, by w�ay of loan, gifr, conn or otl�envise, other than already disclosed in tbe application n•hich I herewith s mitted. I aiso understand this premise may be inspected b}• police, fue, health and othet city officials at any and all times a hen the�iu e�c�ts��u operatioa. Si�2ture '"*'loge: If ahis application is Foodff�sqnor re7ated please conta: t a City of Sain[ Paul Health Tnspectoz, Steve Olson (266-9139}, to review plans. If azry svbseaoeial ePaanges to �zc�ac%ure are anticipated, pleace conract a Ciry, of Saint Paul PIan F�amines at 266-9007 to apply for `onild'u3g pemuase 5f �er� a*� az�* cb��es 20 2he pazkin� icY, S}oca sp�, �r �or new operations, please contact a City of Saint Paul Zoning Insp=ctot z,� c66-��,t7�. ��dti��z�." a�� a�;aa r€��°��„�, �� E3aciae `,� ��4aa��. �e�i��n �zi �r.� 2�a�€��, Ios��ss�, ��si �a�� °s�a�� a�'EPa� pa¢mises to flre laceaasesH (s§d¢ �fl�� 4' .�� " :;..,� ' _ . °sz'�, f p r- :e oe ee ev � ��:� _�m c� :.� � _ :-= s�fic� �.� . - ��"� e:� ��. � }/� .x g� �� 1/� as �� g^r�ss � ?b°a°ys� a;�i�.,�:s� �ia�':'aros�� ir �Le�, _ � s�� a¢�d � �s�£� �Er�ka � 1" ° 2tf°e "�` s�ou�d � r�€iss�Y� t�rs�rd �fie fop, - P3��ew�2�k o� � �^��-+, �en4 ��a�� g g$�e aaa°�rao� ��' a'±e �Sm�� ci�i4� sucBa as §ea��a� �a�a� �tsh¢�, o�S� repair �ce� ;��,; ��, s°es� : ;e.;_5p �4� � I� ��¢�uesf es eoa� a� ��d°ak�cr� aN �a��sSoae ea� ?Eae isegz��sa a�e:�3�, �saae2�� a�s F�� sefl �. a� �se� E�� r�posed @��PASB6� ..�L i.�� .�.° EEaa-"; ?�^L°'�.'��'zi_.�',i L Ci 7SsC':r� i � .�.�4c,'(."PSET�_'„ �'_ ��. '_ - "' , . ��J� �CJ ��.�-�'� ��`°I� � , �tt�`-: :�, Council File # 1� � �� ordinance � Green Sheet $ �� SAINT MINNESOTA ! / Presented By Referred To Committee: Date i RESOLVED: That application (ID #18491) for an On Sale Malt (3.2) and Restaurant-B License by z Megusta Mexican C�isine Inc. DBA Megusta Mexican Restaurant (Modesto Reyes, s President) at 433 Robert Street South be and the same is hereby approved. 4 5 6 Yeas Nays Absent 7 B ak� � 9 r Ha r zs M � g � 10 � Me a � I1 Re tt man �/' 12 Thune 13 Bostrom � 15 6 C� 16 Adopted by Council: Date ��,\a, � l�{ 17 18 Adoption Certified by Council Secretary 19 20 {'� 21 BY. �---� � . F�� 22 —�- j 23 Approved by Mayor: Date 2//4 ��7- 24 �//� 25 c 26 By: �- 27 Requested hy Department of: Office of License Inspections and Environmental Protection By: �1 �"7'�%+�- - - - Form Approved by City Attorney By: / � Approved by Mayor for Submission to Council By: q�_►y�r OEPARTMENT/OFFICf./GOUNCIL DpiE�NR1ATED GREEN SHEE N� 35383` LIEPjLicensing -- -- CO ACf PERSON d PHONE O pEPARTMENT DIRECTOR mpwA O CIN COUNGL � Au�� CT'ATfOHNEY CT'CLERK Christine Rozek, 266-9108 xureexwe MUST BE ON COUNCIL AGENDA BY (DATE) R�� O BUDGEf DIRECTO � FlN. & MGT. SEHVK.ES DIR. For hearin : � � OBUEq 0 �� 0 TOTAL # OF SIGtiATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REWESiED: Megusta Mexican Cuisine INc. DBA Megusta Mexican Restaurant requests Council approval of its application £or an On Sale Malt (3.2) and Restaurant-B License located at 433 Robert Street South (ID �P18491). AECOMMENDATONS: ApWOVe (A) ar Heject (R) pERSONAI SERtlICE CONSRACTS MUST ANSWER 7HE FOLLOWING �UESTIONS: _ PIANNING C�MMISSION _ GVII SERVICE COlnM�SSiON �- Has tliis perwNF7rm ever worked under a cOntract for ihis departmerrt? - _ CIB COMMITTEE YES NO _ STp�F ` 2. Has this perso�rm ever been a ciry employee2 — YES NO — a��T �� — 3. Does this persoMirm possess a skill not normaYry possessed by arry curtent city emplqree? SUPPOFiiSWHICHCWNCILOBJECTIVE? YES NO Explefn all yes answecs on separate sheet end ettach to green sheet INITIATING PROBLEM, ISSUE, OPPf.1NTUNITY (Who, Whet, When. Whera, Why�: � R�C��'�� N4V 3 5 M�96 C��Y AT��'� ADVANTAC+ESIFAPPROVED: - DISADVANiAGES 4f APPROVE�: �{Vm9kt°`as� F's'�a�?.'�?°^�4E. k;H�'�`YdYb � � �5�+� �^–"°�� _r DISADVANTAGESIFNOTAPPflOVED: . . " TOTAL AMOUNT OF TRANSAC710N S COST/REVENUE BUD6E7E0 (CIRCLE ONE) YES NO EUNOING SOURCE ACTIVlTY NUMBER FINANCIAL INfORMATION. (EXPLAIN) Greensheet �t 35383 L.I.E.P. REVIEW CHECKLIST Date: 11/7196 �/ `� `1-1t-1 � In Tracker? I 9 app�n Recerved / npp�n arocessea LicenselD # 18491 License Type: �n Sale Malt (3.2) and Restaurant-B Company Name: Megusta Mexican Cuisine Inc. DBA: Me¢usta Mexican Restaurant Business Addresss: 433 Robert St S Bus+ness Phone: 227-3533 Contact NamejAddress: Modesto Reves, 103 Blake Road N Home Phone: 938-5337 Hop ins, 5343 Date to Council Research: I �, / Public Hearing Date:� � Q� Labels Ordered: �`/ Notice Sent to Appiicant: District Council #: � ��ll�6ll�.l,f Notice Sent to City Attomey Date inspections • l t`� Environmental Heaith 2 • 2D•Rlo I D,� . Fire License Police Zoning �2- 10'q(o Ward Comments � � 1 (1 ,� Siu Pian Aeceived� (,�j.�n �,,,� bi.[,L.y�t,ca,�j_.�p . Lease Received: '— il {I �� .G�-�-, � �- _ .�, a, .��.,� t> .� - e _ :� , j �1I -- �,�� Type of License(s) being applied for: � Compaoy;:as�: PLEASE'I'YPE OR PRL'��i' L'� L\K / Panne�ship / Sole Proprieiontup If business is incorpc Doing Business .As: Business Addrzss: _ Between what cross streetr is rhe business located? 1`��bLr 1'�t-. �+^o� Are the premises now occupied? .�2�� V�'l�at Type of Business? _ '�fail To Address: `/ 5 5 5 0. K-m a� Str�t Address Applicant Infor�paa on�: '�azne aud T±t��. Y (Y � �eS �Q � First n Tliddle Ho� Addre�.: n Ciry Iast N _ _�� _�_ Zip , w�d s, d� sneet? �dR�beri-S{_ � /�� d J S�(?�' S:2te Zip �/�PS'� ��rn,T Title S �r3 Scr�� Addras v V Ciry � S�te � , Z r ip Dat� ot Bir[h: ,_ Q�� S� Place of Birda: � xU (�� Bf� f�t' Phone: G�� -? � Have yo� �ver �zen convict:,d of any felony, cri� or viol�°.ion of any city ordinance other than trafFic? YES _�i0,� Date of � � .;sc Chaz�e: _ Cooviction• Sentence: �ist the name� and reside_-�;: wf ihree r�egsons of good racral chazacter, living w•ithin the Twin Cities Metto Area, not related to the applicant or fmancially ir�<;; ��r�a in efie premises or business, ��bo may be refesed to as to the applicant`s c6aracter: CLASS III CITY OF SAL\'T PAUL �1Cl.tV.7L 1 � OfficeofticenSe,I[L�tians 2�d Em�wnmen:at ?ntecuon :�'1SC PcaA Suec 3DJ s+tmn��sro�s�s ss�c� (612)166� ?i?4 y,��`��' �r�� -I `-t�' THIS APPLICATIO'�T IS SL TO REVIEW BY TI� PL'BLIC 4z�ere? ADDRES� -�;�,�. ".�r PHOh'E li ��e^1✓ine� ��o�P �� 1i2 �2" So �P,,�S M�.1 �i�.�C1�3,��61L�305 4��id 6 List licenses whic6 yoL cirre��iy fao7d, fo_*�.w; iy held, c�2y ha an in4e in. /�; .� � c� '( � ct S'�P` b�G De �e r W�� Li Gt,°K� �° !✓t ( � l.�e. G f�` r Have any of the above named �censes eeer E�cen revoked? _ a£S �TO If yes, list the dates aud reas� s for rev�ation: Are you goina �� oper�ee sfiis-buszaess �rs; :��"7? �_ i'FS �� n . s�'� ��,s -�.gFq :z�'s'� oper�2� it? First tna.*,^ Middse In'su� ;2.1air_";,te' liS<. Home Addr,�ss: ��,[ A.arr� ' _ _ _ . � � �� .___. .—�., SeaBc Which side of tbe �L'au of Binh .... . , , -� r�scce h:!nSu StteetAddrest �.ny � State t�re }ou gomc to na� e a manager or as<ytant m uvs busioess.' zta � �v u u�e managez �s nui �nc �u,X � u,� �E;,a��,by,,�a,� complete tiie follow•ing infocmation: �� ' _ g� - i�� Fnt�� i�a;��m;a� t+iva�,,, t<« m,�oss;nh Home Addras: S¢ea �zme Cip� Suie Zip List all other officen of tbe corporation: O�ICER TII'LE HOA� ':vA'v1E (Office Held) � ADDRE; HOME PHO\'E BliSI!�'PSS PHO\� r L) �2�- If business is a parmeiship, piease ine3ude t6e follow=ine informauon for each parmer (use addivonal paaes if nezessary�): Fvsc?:azne !.liddle Inival Home Ad&ess: Strea?:ame Fi7st Rame 1.4iddie In"rtia! (Maiden) City (:.Saiden) tast Su�e Zip Last D ATE QF BIl2TH Ola 1(SI t Date of Birth Due Home Address: Sueee ha� City S�ate Zip PLone Numbu ML'�°t�'ESOTA TAX IDET."dTEICATIOti i�'U�NIDER - Pursuant to the Laws of Nfinnesota, 1984, C1�apter 502, Anide S, Section 2(270.72} (Taz =Pearaece; Lssuaace ar tacensesJ, licenssr�� ;��orities are cequired tc> pro��ide co the State of Minnesota Commissioner of Revenue, rbe ;-;i:nesota �Susinass eax gden��icavo� nu�er u,� tf�e soclal securiry nnmber of each license applicanc - 'ni =. °_'e Y�.=•� s:�a : �„a: _ �ai �'�c:.,-, ;; za:� tge Fe?�r ivacy Act oa :9'J4, we are required to advise you of the follow�ing regarcfing the �se ��'+�e at�;�u�s�: a Tae idenafi�a�o� I'aTUmhe;: - This x..�e;, ��axic,�± �y se used tn deny ehe issuance or zesewat of you[ license in the event you owe T�tinnesota saies, emplo}�er s withholGtn� :,_ aaoEOS E�ehicle ezcise ta2es; - Upon a�ceF�ring Fi�i, ;��fom�asion, the I�censang auc�oriry utll supply it only to she Minuesota Deparm�nt of Revenue. However, und�r e� r�e�ra& �zchsnge of Infoimaeion � greeement, the Depazt�nt of Revenae may supply this information to rhe ;ntemal �L€y��.: -_a�c�. iKi�,< � s- ;c�e,��Fcaxioa A�umL�rs (�aIe� & Use Ta� k-`�m�xer; may be obtaine3 from tbe Stau of Minnesota, Business lZecoids �epac��=_; °: i�. - 'ar`xPla�° (61�-296 �'sg�� Soc;a w_.._:. =.`� i ��mber. � S' Q �l - � � � �'v..- `", ',__ , �. ,rj01]GfF�3.Ct�w� 1l t ° D � V �� . ,� _ ��. idiinnssa�, z a*. 3der,i.i.ncz:�io� i � azrzc�- as �ot s�auL�ea �'c ';r �usicess uei�g �e, indicat� ss �y g�lacing a,� "X" in the �v:... Ple,�ce list your emplo;ment history for the precious five (�) }eaz period: � - ^t°ERTIfTCATIO\ OF WORKERS' C0;�IPENSATION COV£R?.GE PliRSliA\'I' TO :�1L*ti�'ESOTA STAIUTE 176.182 I hereby certify tbat I, or my company, am in compliance with che w•orkers' comFxxasation insurance coverage requuement� of Alionesota Sumte 176.] 82, sub3ivision 2. I also understand tbat provisioa of false info�tion in this certifrcation consdmtes sufficient grounds for adcene acuon aeainst atl licenses he] mcluding re ad suspension of said licenses. ��2me of Insurance Company � Q,/' f—G 1-y �� j S�FR'T�4 f'S Polic ;��umber: � 7` �� 3 T O �e from � 4 �J to 3 D t `� � y � � � Co�'era, I b�ce no employees coeered under k�od:ers' compensation insurance - �� —�� A�\'Y FAISffICATI0:1 OF A:\S« ERS GI4'E?� OR'�1.4TERIAL SUB;��TTEB R�II,L RESULT L\ D�7AL OF THIS APPLICATIO:\T I bereby state that I have answered all of the preceding quesfions, and tf�at the informapon contained herein is true and corrut to the best of my knoa�ledge and belief. I hereby state fiuther tbat I ba��e nceived no mone � or other consideration, by w�ay of loan, gifr, conn or otl�envise, other than already disclosed in tbe application n•hich I herewith s mitted. I aiso understand this premise may be inspected b}• police, fue, health and othet city officials at any and all times a hen the�iu e�c�ts��u operatioa. Si�2ture '"*'loge: If ahis application is Foodff�sqnor re7ated please conta: t a City of Sain[ Paul Health Tnspectoz, Steve Olson (266-9139}, to review plans. If azry svbseaoeial ePaanges to �zc�ac%ure are anticipated, pleace conract a Ciry, of Saint Paul PIan F�amines at 266-9007 to apply for `onild'u3g pemuase 5f �er� a*� az�* cb��es 20 2he pazkin� icY, S}oca sp�, �r �or new operations, please contact a City of Saint Paul Zoning Insp=ctot z,� c66-��,t7�. ��dti��z�." a�� a�;aa r€��°��„�, �� E3aciae `,� ��4aa��. �e�i��n �zi �r.� 2�a�€��, Ios��ss�, ��si �a�� °s�a�� a�'EPa� pa¢mises to flre laceaasesH (s§d¢ �fl�� 4' .�� " :;..,� ' _ . °sz'�, f p r- :e oe ee ev � ��:� _�m c� :.� � _ :-= s�fic� �.� . - ��"� e:� ��. � }/� .x g� �� 1/� as �� g^r�ss � ?b°a°ys� a;�i�.,�:s� �ia�':'aros�� ir �Le�, _ � s�� a¢�d � �s�£� �Er�ka � 1" ° 2tf°e "�` s�ou�d � r�€iss�Y� t�rs�rd �fie fop, - P3��ew�2�k o� � �^��-+, �en4 ��a�� g g$�e aaa°�rao� ��' a'±e �Sm�� ci�i4� sucBa as §ea��a� �a�a� �tsh¢�, o�S� repair �ce� ;��,; ��, s°es� : ;e.;_5p �4� � I� ��¢�uesf es eoa� a� ��d°ak�cr� aN �a��sSoae ea� ?Eae isegz��sa a�e:�3�, �saae2�� a�s F�� sefl �. a� �se� E�� r�posed @��PASB6� ..�L i.�� .�.° EEaa-"; ?�^L°'�.'��'zi_.�',i L Ci 7SsC':r� i � .�.�4c,'(."PSET�_'„ �'_ ��. '_ - "' , . ��J� �CJ ��.�-�'� ��`°I� � , �tt�`-: :�, Council File # 1� � �� ordinance � Green Sheet $ �� SAINT MINNESOTA ! / Presented By Referred To Committee: Date i RESOLVED: That application (ID #18491) for an On Sale Malt (3.2) and Restaurant-B License by z Megusta Mexican C�isine Inc. DBA Megusta Mexican Restaurant (Modesto Reyes, s President) at 433 Robert Street South be and the same is hereby approved. 4 5 6 Yeas Nays Absent 7 B ak� � 9 r Ha r zs M � g � 10 � Me a � I1 Re tt man �/' 12 Thune 13 Bostrom � 15 6 C� 16 Adopted by Council: Date ��,\a, � l�{ 17 18 Adoption Certified by Council Secretary 19 20 {'� 21 BY. �---� � . F�� 22 —�- j 23 Approved by Mayor: Date 2//4 ��7- 24 �//� 25 c 26 By: �- 27 Requested hy Department of: Office of License Inspections and Environmental Protection By: �1 �"7'�%+�- - - - Form Approved by City Attorney By: / � Approved by Mayor for Submission to Council By: q�_►y�r OEPARTMENT/OFFICf./GOUNCIL DpiE�NR1ATED GREEN SHEE N� 35383` LIEPjLicensing -- -- CO ACf PERSON d PHONE O pEPARTMENT DIRECTOR mpwA O CIN COUNGL � Au�� CT'ATfOHNEY CT'CLERK Christine Rozek, 266-9108 xureexwe MUST BE ON COUNCIL AGENDA BY (DATE) R�� O BUDGEf DIRECTO � FlN. & MGT. SEHVK.ES DIR. For hearin : � � OBUEq 0 �� 0 TOTAL # OF SIGtiATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REWESiED: Megusta Mexican Cuisine INc. DBA Megusta Mexican Restaurant requests Council approval of its application £or an On Sale Malt (3.2) and Restaurant-B License located at 433 Robert Street South (ID �P18491). AECOMMENDATONS: ApWOVe (A) ar Heject (R) pERSONAI SERtlICE CONSRACTS MUST ANSWER 7HE FOLLOWING �UESTIONS: _ PIANNING C�MMISSION _ GVII SERVICE COlnM�SSiON �- Has tliis perwNF7rm ever worked under a cOntract for ihis departmerrt? - _ CIB COMMITTEE YES NO _ STp�F ` 2. Has this perso�rm ever been a ciry employee2 — YES NO — a��T �� — 3. Does this persoMirm possess a skill not normaYry possessed by arry curtent city emplqree? SUPPOFiiSWHICHCWNCILOBJECTIVE? YES NO Explefn all yes answecs on separate sheet end ettach to green sheet INITIATING PROBLEM, ISSUE, OPPf.1NTUNITY (Who, Whet, When. Whera, Why�: � R�C��'�� N4V 3 5 M�96 C��Y AT��'� ADVANTAC+ESIFAPPROVED: - DISADVANiAGES 4f APPROVE�: �{Vm9kt°`as� F's'�a�?.'�?°^�4E. k;H�'�`YdYb � � �5�+� �^–"°�� _r DISADVANTAGESIFNOTAPPflOVED: . . " TOTAL AMOUNT OF TRANSAC710N S COST/REVENUE BUD6E7E0 (CIRCLE ONE) YES NO EUNOING SOURCE ACTIVlTY NUMBER FINANCIAL INfORMATION. (EXPLAIN) Greensheet �t 35383 L.I.E.P. REVIEW CHECKLIST Date: 11/7196 �/ `� `1-1t-1 � In Tracker? I 9 app�n Recerved / npp�n arocessea LicenselD # 18491 License Type: �n Sale Malt (3.2) and Restaurant-B Company Name: Megusta Mexican Cuisine Inc. DBA: Me¢usta Mexican Restaurant Business Addresss: 433 Robert St S Bus+ness Phone: 227-3533 Contact NamejAddress: Modesto Reves, 103 Blake Road N Home Phone: 938-5337 Hop ins, 5343 Date to Council Research: I �, / Public Hearing Date:� � Q� Labels Ordered: �`/ Notice Sent to Appiicant: District Council #: � ��ll�6ll�.l,f Notice Sent to City Attomey Date inspections • l t`� Environmental Heaith 2 • 2D•Rlo I D,� . Fire License Police Zoning �2- 10'q(o Ward Comments � � 1 (1 ,� Siu Pian Aeceived� (,�j.�n �,,,� bi.[,L.y�t,ca,�j_.�p . Lease Received: '— il {I �� .G�-�-, � �- _ .�, a, .��.,� t> .� - e _ :� , j �1I -- �,�� Type of License(s) being applied for: � Compaoy;:as�: PLEASE'I'YPE OR PRL'��i' L'� L\K / Panne�ship / Sole Proprieiontup If business is incorpc Doing Business .As: Business Addrzss: _ Between what cross streetr is rhe business located? 1`��bLr 1'�t-. �+^o� Are the premises now occupied? .�2�� V�'l�at Type of Business? _ '�fail To Address: `/ 5 5 5 0. K-m a� Str�t Address Applicant Infor�paa on�: '�azne aud T±t��. Y (Y � �eS �Q � First n Tliddle Ho� Addre�.: n Ciry Iast N _ _�� _�_ Zip , w�d s, d� sneet? �dR�beri-S{_ � /�� d J S�(?�' S:2te Zip �/�PS'� ��rn,T Title S �r3 Scr�� Addras v V Ciry � S�te � , Z r ip Dat� ot Bir[h: ,_ Q�� S� Place of Birda: � xU (�� Bf� f�t' Phone: G�� -? � Have yo� �ver �zen convict:,d of any felony, cri� or viol�°.ion of any city ordinance other than trafFic? YES _�i0,� Date of � � .;sc Chaz�e: _ Cooviction• Sentence: �ist the name� and reside_-�;: wf ihree r�egsons of good racral chazacter, living w•ithin the Twin Cities Metto Area, not related to the applicant or fmancially ir�<;; ��r�a in efie premises or business, ��bo may be refesed to as to the applicant`s c6aracter: CLASS III CITY OF SAL\'T PAUL �1Cl.tV.7L 1 � OfficeofticenSe,I[L�tians 2�d Em�wnmen:at ?ntecuon :�'1SC PcaA Suec 3DJ s+tmn��sro�s�s ss�c� (612)166� ?i?4 y,��`��' �r�� -I `-t�' THIS APPLICATIO'�T IS SL TO REVIEW BY TI� PL'BLIC 4z�ere? ADDRES� -�;�,�. ".�r PHOh'E li ��e^1✓ine� ��o�P �� 1i2 �2" So �P,,�S M�.1 �i�.�C1�3,��61L�305 4��id 6 List licenses whic6 yoL cirre��iy fao7d, fo_*�.w; iy held, c�2y ha an in4e in. /�; .� � c� '( � ct S'�P` b�G De �e r W�� Li Gt,°K� �° !✓t ( � l.�e. G f�` r Have any of the above named �censes eeer E�cen revoked? _ a£S �TO If yes, list the dates aud reas� s for rev�ation: Are you goina �� oper�ee sfiis-buszaess �rs; :��"7? �_ i'FS �� n . s�'� ��,s -�.gFq :z�'s'� oper�2� it? First tna.*,^ Middse In'su� ;2.1air_";,te' liS<. Home Addr,�ss: ��,[ A.arr� ' _ _ _ . � � �� .___. .—�., SeaBc Which side of tbe �L'au of Binh .... . , , -� r�scce h:!nSu StteetAddrest �.ny � State t�re }ou gomc to na� e a manager or as<ytant m uvs busioess.' zta � �v u u�e managez �s nui �nc �u,X � u,� �E;,a��,by,,�a,� complete tiie follow•ing infocmation: �� ' _ g� - i�� Fnt�� i�a;��m;a� t+iva�,,, t<« m,�oss;nh Home Addras: S¢ea �zme Cip� Suie Zip List all other officen of tbe corporation: O�ICER TII'LE HOA� ':vA'v1E (Office Held) � ADDRE; HOME PHO\'E BliSI!�'PSS PHO\� r L) �2�- If business is a parmeiship, piease ine3ude t6e follow=ine informauon for each parmer (use addivonal paaes if nezessary�): Fvsc?:azne !.liddle Inival Home Ad&ess: Strea?:ame Fi7st Rame 1.4iddie In"rtia! (Maiden) City (:.Saiden) tast Su�e Zip Last D ATE QF BIl2TH Ola 1(SI t Date of Birth Due Home Address: Sueee ha� City S�ate Zip PLone Numbu ML'�°t�'ESOTA TAX IDET."dTEICATIOti i�'U�NIDER - Pursuant to the Laws of Nfinnesota, 1984, C1�apter 502, Anide S, Section 2(270.72} (Taz =Pearaece; Lssuaace ar tacensesJ, licenssr�� ;��orities are cequired tc> pro��ide co the State of Minnesota Commissioner of Revenue, rbe ;-;i:nesota �Susinass eax gden��icavo� nu�er u,� tf�e soclal securiry nnmber of each license applicanc - 'ni =. °_'e Y�.=•� s:�a : �„a: _ �ai �'�c:.,-, ;; za:� tge Fe?�r ivacy Act oa :9'J4, we are required to advise you of the follow�ing regarcfing the �se ��'+�e at�;�u�s�: a Tae idenafi�a�o� I'aTUmhe;: - This x..�e;, ��axic,�± �y se used tn deny ehe issuance or zesewat of you[ license in the event you owe T�tinnesota saies, emplo}�er s withholGtn� :,_ aaoEOS E�ehicle ezcise ta2es; - Upon a�ceF�ring Fi�i, ;��fom�asion, the I�censang auc�oriry utll supply it only to she Minuesota Deparm�nt of Revenue. However, und�r e� r�e�ra& �zchsnge of Infoimaeion � greeement, the Depazt�nt of Revenae may supply this information to rhe ;ntemal �L€y��.: -_a�c�. iKi�,< � s- ;c�e,��Fcaxioa A�umL�rs (�aIe� & Use Ta� k-`�m�xer; may be obtaine3 from tbe Stau of Minnesota, Business lZecoids �epac��=_; °: i�. - 'ar`xPla�° (61�-296 �'sg�� Soc;a w_.._:. =.`� i ��mber. � S' Q �l - � � � �'v..- `", ',__ , �. ,rj01]GfF�3.Ct�w� 1l t ° D � V �� . ,� _ ��. idiinnssa�, z a*. 3der,i.i.ncz:�io� i � azrzc�- as �ot s�auL�ea �'c ';r �usicess uei�g �e, indicat� ss �y g�lacing a,� "X" in the �v:... Ple,�ce list your emplo;ment history for the precious five (�) }eaz period: � - ^t°ERTIfTCATIO\ OF WORKERS' C0;�IPENSATION COV£R?.GE PliRSliA\'I' TO :�1L*ti�'ESOTA STAIUTE 176.182 I hereby certify tbat I, or my company, am in compliance with che w•orkers' comFxxasation insurance coverage requuement� of Alionesota Sumte 176.] 82, sub3ivision 2. I also understand tbat provisioa of false info�tion in this certifrcation consdmtes sufficient grounds for adcene acuon aeainst atl licenses he] mcluding re ad suspension of said licenses. ��2me of Insurance Company � Q,/' f—G 1-y �� j S�FR'T�4 f'S Polic ;��umber: � 7` �� 3 T O �e from � 4 �J to 3 D t `� � y � � � Co�'era, I b�ce no employees coeered under k�od:ers' compensation insurance - �� —�� A�\'Y FAISffICATI0:1 OF A:\S« ERS GI4'E?� OR'�1.4TERIAL SUB;��TTEB R�II,L RESULT L\ D�7AL OF THIS APPLICATIO:\T I bereby state that I have answered all of the preceding quesfions, and tf�at the informapon contained herein is true and corrut to the best of my knoa�ledge and belief. I hereby state fiuther tbat I ba��e nceived no mone � or other consideration, by w�ay of loan, gifr, conn or otl�envise, other than already disclosed in tbe application n•hich I herewith s mitted. I aiso understand this premise may be inspected b}• police, fue, health and othet city officials at any and all times a hen the�iu e�c�ts��u operatioa. Si�2ture '"*'loge: If ahis application is Foodff�sqnor re7ated please conta: t a City of Sain[ Paul Health Tnspectoz, Steve Olson (266-9139}, to review plans. If azry svbseaoeial ePaanges to �zc�ac%ure are anticipated, pleace conract a Ciry, of Saint Paul PIan F�amines at 266-9007 to apply for `onild'u3g pemuase 5f �er� a*� az�* cb��es 20 2he pazkin� icY, S}oca sp�, �r �or new operations, please contact a City of Saint Paul Zoning Insp=ctot z,� c66-��,t7�. ��dti��z�." a�� a�;aa r€��°��„�, �� E3aciae `,� ��4aa��. �e�i��n �zi �r.� 2�a�€��, Ios��ss�, ��si �a�� °s�a�� a�'EPa� pa¢mises to flre laceaasesH (s§d¢ �fl�� 4' .�� " :;..,� ' _ . °sz'�, f p r- :e oe ee ev � ��:� _�m c� :.� � _ :-= s�fic� �.� . - ��"� e:� ��. � }/� .x g� �� 1/� as �� g^r�ss � ?b°a°ys� a;�i�.,�:s� �ia�':'aros�� ir �Le�, _ � s�� a¢�d � �s�£� �Er�ka � 1" ° 2tf°e "�` s�ou�d � r�€iss�Y� t�rs�rd �fie fop, - P3��ew�2�k o� � �^��-+, �en4 ��a�� g g$�e aaa°�rao� ��' a'±e �Sm�� ci�i4� sucBa as §ea��a� �a�a� �tsh¢�, o�S� repair �ce� ;��,; ��, s°es� : ;e.;_5p �4� � I� ��¢�uesf es eoa� a� ��d°ak�cr� aN �a��sSoae ea� ?Eae isegz��sa a�e:�3�, �saae2�� a�s F�� sefl �. a� �se� E�� r�posed @��PASB6� ..�L i.�� .�.° EEaa-"; ?�^L°'�.'��'zi_.�',i L Ci 7SsC':r� i � .�.�4c,'(."PSET�_'„ �'_ ��. '_ - "' , . ��J� �CJ ��.�-�'�