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97-2581 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 `��1 �-, E �' ` �', t ('?` � i Presented By Referred To Committee: Date RSSOLVED: That application, ID #14435, Por a new Auto Repair Garage License by J.P. Automotive DsA J.P. Automotive (Jeffrey Phillip O•Brien) at 933 Atlantic Street #2, be and the is hereby approved. Requested by Department of: Adopted by Adoption �e i � By: ��/ Approved by Council File # �� — � 5 � RESOLUTiON CITY OF SAINT PAUL, MINNESOTA �� Ordinance # Green Sheet # 35439 5� Secretary Date �S/ } Bys �- - • - -�_- :=.- .�_ _,. , •��,-� - ., BY% / T ""'<C�.� Form Approved by City Attorney BY � J .li✓�-� � Approved by Mayor for Submission to Council By: /+ . + D LIEP NT/OFFICHCOUNCIL DATE INRIATED �REEN SHEE N_ 3 5 4 3 9 CANiACT PERSON 8 PXON INRIALNA7E INITIAUDATE O DEPAqTMEM DIRECTOR O CRY COUNCiI Christine Rozek - 266-9108 ASS�GN �CRVATfORNEY �CRYCLERK NUMBEHiON MUST BE ON COUNCIL AGENDA BY (DAT� ) R�� BUOGEf �IflECTOR � FlN. 8 MGT. SEHVICES DIR. Hearing: 3 ��a��7 OROQt ��ypypR{pRAS$ISTANT) Q TOTAL # OF SIGNATURE PAGES � (CLIP ALL LOCATIONS FOR SiGNATURE) AC7ION fiEQUESTED: J.P. AutomoYive DBA J.P. Automotive (Jef£rey Phi3.lip 0'Brien) at 933 Atlantic Street #2 requests Council approval of a new Auto Repair Garage License. (ID 9{14435) PECOMMENDATIONS: Approve (n) or Reject (R) pER50NAL SERVICE CONTRACTS MUSTANSWER TNE fOLLOWING �UESTIONS: _ PLANNING COMMISSION _ qVll SERVICE CAMNASSION �� Has Mis persoNfirm ever worked under a contract for Mis deparhneM? - _CIB((bMMfTTEE _ YES "NO _ STAFF 2. Has Mis personflirm ever been a city empbyee? — YES NO — a��T �RT — 9. Daes [h1s personlFirtn possess a skAl not normal � ry possessed by any currem ciry employee. SUPPORTSWHICHCOUNC�LOBJECTIVE? YES NO Ezplain all yes answers on separete sheet anA attaoh W green sheet INITIATING PROBLEM. ISSUE, OPPORTUNITY (Who, NTet, When. Where, Why): � ADYANTAGES IF APPROVEO; DISADVANTAGES IFAPPHOVED: DISADVANTAGES IF NOTAGPROVED: v s , �$s[M . � `�_% �. �? '.��7 TOTAL AMOUNT OF TRANSACTION S COST7REYENUE BUDGETEO (GIRCIE ONE) YES NO FUNDIHG SOUpCE ACTIVITY NUMBER ' FINANCIAI INF�RMATION: (EXPLAIN) � Greensheet # 35439 L.I.E.P. REVIEW CHECKLIST Date: / Ifl TraCkef.�_� !� nPP'n Rec;eived / APP'n Processed q� a�8 License ID # 14435 License Type: Auto Repair caragP COmpany Name: J.P. Automotive DBA: J. P. Automotive Business Addresss: 933 Atlantic Street �t2 Business Phone: 772-2735 Contact Name/ Date to Councii Public Hearing Notice Sent to , lip 0'Brien Home Phone: 702— 2 Ave. 4�303 55119 'v `,�rs-• f �i C� � Labels Ordered: � �} District CoUnal #: 04 Notice Sern to Pubiic: Ward #: 06 DepartmentJ Date lnspeetions Comments City Attomey �'�'��" Environmental Health 2•5•9�- �}.� . Fire 2-'�J+�t�" C�•� • LIC2Ils8 Site Plan Received:_ Leese Received: ��,� J �� %--� Police 2 •5''°t�- �.� . Zoning 2,� 0.�, . . .. ��-�� 35 �� y� �'4� � ' '''�' �� CLASS III CTTY OF SAINT PAUL d �' � `r .��. ``' !.. i � ? O�ce of License. Inspcctions LICENSE APPLICATION �„a E,,, r��o„ JAff ! 3 9 43 �� '91 130 Sc Pes¢ $c Sui�e 300 Sain� Au�. Mimmu ,5�01 (613) 26&9090 fa (612) 3669124 THIS APPLICATION IS SUBJECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT IN INK Type of License being applied for: Busiaess RL1TpMOTI V� (�EPRI I� — GENE��-�- Company Name: J P Automotive Coryoruion / Paimaship / Sok Prop=ietoiship If business is incorporeted, give date of inco:pontion: _ Doing Business As: J P Automotive Business Phone: C612) 772-2738 BusinessAddress: 433 Atlantic St Unit 2 St. Paul MN 55106 •� Streec Addsess City State Zip Between what cross streets is the business located? Atlantic and Duluth Which side of the street? West Are the premises now occupied? YeS What ofBusiness? Automotive repair Mail To Address: 933 Atlantic St Unit 2 St. Paul MN 55106 Shee[ Address City Smte Zip Applicant Information: Name and Tiile: Seffrey Phillip 0'Brien Owner First " 2vLddle (Maiden) Lasc Title HomeAddress: 1957 WiZson Avenue Apartment 303 St. Paul MI3 55119 Stree[ Abdress Ciry State �p DateofBirth: December 28, 1956 placeofBirth: International Fa11 HomePhone: t612� 702-9923 y � Yes Minnesota Are ou a citizen of the United States? Native. Naturalized? --- If you are not a U.S. citizen, you must have work authorization from the U.S. Immigration & Naturalization Service. Have. you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES X NO _ Dateofarsest: Unsure (1986???) Where? Rock Springs, Wyoming Chazge: Assault Conviction: Guilty Sentence: 10 days in jail iist rhz :ames ar.d resi; er.ces of three �rse�s oi good monl chasactsr, living witY:in the Twin Cities Metro Area, not retated to tiie applicant or financiaily interested in the premises or business, who may be referred to as to the appiicanYs character: NAiv� Rar1 Brogxen Jim Schaetzel Bill Shappel ADDRESS 9376 I3 SSth St. Lake Elmo, MN 55042 3933 Bellaire White Bear Lk MN 55110 363 Atwater St Pau1 MN 55117 List licenses which you currently hold, formerly held, or may have an interest in: Class "A" driver's license PHONE (612) 770-6002 (612) 407-8530 (612) 489-34�4 Have any of the above named Iicenses ever been revoked? _ YES X NO If yes, list the dates and reasons for revocation: Are you going to opente this business personally? First Namc h5ddle Initial X YES � NO If not, who will opernte it? (Maiden) LaSt Home Addrcss: Street Name City Stare Zip Date of B'vth Phone Number � � i-a5� Are you going to have a manager or assistan[ in this business? X ygS _ NO If the manager is not the same as the operator, �� pleue complete the following information: Shannon M. Klisch 0'Brien March 30, 1969 Fiist Name IrLddie Initia! (Maidrn) lasc Datc of Hitth 1957 Wilson Avenue Apartment 303 St. Paul MN 55119 (612)702-99� tfome qamess: Sueet Nmne Statc Zip _ _ -- Phonc Num6es Cay Please list your employment history for the previous five (5) yeaz period: BusinessfEmnlovment Address 02/94 - now J P Automotive (Se nemp oye ue o (1R79� _ n619'i C„1,,,+7,�„ r��. rco 933 Atlantic St. St. Paul MN au accz en owner operator) St. Paul MN 04/92 - O8{92 Wright Tree Service Man ato MN ��8��t9�—�a�rarbg� 6ab �ea$c�s MN OS191 - 09)91 Wri ht Tree Service Mankato MN 11/90 - OS/91 Timberline Tree Service St. Pau List al] other officen of the corgoration: OFFICER TITLE HOME NAME (Office Aeld) ADDRESS 23ot Applicable....... HOME HUSR?ESS BATE OF PIiONE PHONE BIRTH If business is a parmership, please include the following information for each pamier (use additionai pages if necessary): Not Applicable....... F'ust Name Middle Inrosi (Maidtn) Las[ Date of Birth . Aome Addrcss: Street Name �--� � Cih - -' Siau - 7 Phone Number First Name Middle Initial (Maiden) Last Date of Buth Aomc Addttss: Street Name C7ty State Zip Phone Number MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant w the Laws of Minnesota, 1984, Chapter 502, Article 8, Secaon 2 (270.72) (Ta�; Cleazance; Issuance ofLicenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tas identification number and the social security number of each license applicant. Under the Minnesota Govemment Data Practices Act and t6e Fedeml Privacy Act of 1974, we are required to advise you of the following regarding the use of t6e Minnesota Tax Identification Number. - This information may be used to deny the issuance or renewal of your license in the event you owa Minnesota sales, employer's withholding or motor vehicle eaccise tases; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Informarion Agreement, the Depamnent of Revenue may supply this information to the Internai Revenue Service. Minnesota Tax Identification Numbers (Sales & L3se Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6181). Social SecurityNumber: 477-70-ki42 Minnesota Tax Identification Number: 139-7331 � _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by p}acing an "X" in the tiox. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 `��1 �-, E �' ` �', t ('?` � i Presented By Referred To Committee: Date RSSOLVED: That application, ID #14435, Por a new Auto Repair Garage License by J.P. Automotive DsA J.P. Automotive (Jeffrey Phillip O•Brien) at 933 Atlantic Street #2, be and the is hereby approved. Requested by Department of: Adopted by Adoption �e i � By: ��/ Approved by Council File # �� — � 5 � RESOLUTiON CITY OF SAINT PAUL, MINNESOTA �� Ordinance # Green Sheet # 35439 5� Secretary Date �S/ } Bys �- - • - -�_- :=.- .�_ _,. , •��,-� - ., BY% / T ""'<C�.� Form Approved by City Attorney BY � J .li✓�-� � Approved by Mayor for Submission to Council By: /+ . + D LIEP NT/OFFICHCOUNCIL DATE INRIATED �REEN SHEE N_ 3 5 4 3 9 CANiACT PERSON 8 PXON INRIALNA7E INITIAUDATE O DEPAqTMEM DIRECTOR O CRY COUNCiI Christine Rozek - 266-9108 ASS�GN �CRVATfORNEY �CRYCLERK NUMBEHiON MUST BE ON COUNCIL AGENDA BY (DAT� ) R�� BUOGEf �IflECTOR � FlN. 8 MGT. SEHVICES DIR. Hearing: 3 ��a��7 OROQt ��ypypR{pRAS$ISTANT) Q TOTAL # OF SIGNATURE PAGES � (CLIP ALL LOCATIONS FOR SiGNATURE) AC7ION fiEQUESTED: J.P. AutomoYive DBA J.P. Automotive (Jef£rey Phi3.lip 0'Brien) at 933 Atlantic Street #2 requests Council approval of a new Auto Repair Garage License. (ID 9{14435) PECOMMENDATIONS: Approve (n) or Reject (R) pER50NAL SERVICE CONTRACTS MUSTANSWER TNE fOLLOWING �UESTIONS: _ PLANNING COMMISSION _ qVll SERVICE CAMNASSION �� Has Mis persoNfirm ever worked under a contract for Mis deparhneM? - _CIB((bMMfTTEE _ YES "NO _ STAFF 2. Has Mis personflirm ever been a city empbyee? — YES NO — a��T �RT — 9. Daes [h1s personlFirtn possess a skAl not normal � ry possessed by any currem ciry employee. SUPPORTSWHICHCOUNC�LOBJECTIVE? YES NO Ezplain all yes answers on separete sheet anA attaoh W green sheet INITIATING PROBLEM. ISSUE, OPPORTUNITY (Who, NTet, When. Where, Why): � ADYANTAGES IF APPROVEO; DISADVANTAGES IFAPPHOVED: DISADVANTAGES IF NOTAGPROVED: v s , �$s[M . � `�_% �. �? '.��7 TOTAL AMOUNT OF TRANSACTION S COST7REYENUE BUDGETEO (GIRCIE ONE) YES NO FUNDIHG SOUpCE ACTIVITY NUMBER ' FINANCIAI INF�RMATION: (EXPLAIN) � Greensheet # 35439 L.I.E.P. REVIEW CHECKLIST Date: / Ifl TraCkef.�_� !� nPP'n Rec;eived / APP'n Processed q� a�8 License ID # 14435 License Type: Auto Repair caragP COmpany Name: J.P. Automotive DBA: J. P. Automotive Business Addresss: 933 Atlantic Street �t2 Business Phone: 772-2735 Contact Name/ Date to Councii Public Hearing Notice Sent to , lip 0'Brien Home Phone: 702— 2 Ave. 4�303 55119 'v `,�rs-• f �i C� � Labels Ordered: � �} District CoUnal #: 04 Notice Sern to Pubiic: Ward #: 06 DepartmentJ Date lnspeetions Comments City Attomey �'�'��" Environmental Health 2•5•9�- �}.� . Fire 2-'�J+�t�" C�•� • LIC2Ils8 Site Plan Received:_ Leese Received: ��,� J �� %--� Police 2 •5''°t�- �.� . Zoning 2,� 0.�, . . .. ��-�� 35 �� y� �'4� � ' '''�' �� CLASS III CTTY OF SAINT PAUL d �' � `r .��. ``' !.. i � ? O�ce of License. Inspcctions LICENSE APPLICATION �„a E,,, r��o„ JAff ! 3 9 43 �� '91 130 Sc Pes¢ $c Sui�e 300 Sain� Au�. Mimmu ,5�01 (613) 26&9090 fa (612) 3669124 THIS APPLICATION IS SUBJECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT IN INK Type of License being applied for: Busiaess RL1TpMOTI V� (�EPRI I� — GENE��-�- Company Name: J P Automotive Coryoruion / Paimaship / Sok Prop=ietoiship If business is incorporeted, give date of inco:pontion: _ Doing Business As: J P Automotive Business Phone: C612) 772-2738 BusinessAddress: 433 Atlantic St Unit 2 St. Paul MN 55106 •� Streec Addsess City State Zip Between what cross streets is the business located? Atlantic and Duluth Which side of the street? West Are the premises now occupied? YeS What ofBusiness? Automotive repair Mail To Address: 933 Atlantic St Unit 2 St. Paul MN 55106 Shee[ Address City Smte Zip Applicant Information: Name and Tiile: Seffrey Phillip 0'Brien Owner First " 2vLddle (Maiden) Lasc Title HomeAddress: 1957 WiZson Avenue Apartment 303 St. Paul MI3 55119 Stree[ Abdress Ciry State �p DateofBirth: December 28, 1956 placeofBirth: International Fa11 HomePhone: t612� 702-9923 y � Yes Minnesota Are ou a citizen of the United States? Native. Naturalized? --- If you are not a U.S. citizen, you must have work authorization from the U.S. Immigration & Naturalization Service. Have. you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES X NO _ Dateofarsest: Unsure (1986???) Where? Rock Springs, Wyoming Chazge: Assault Conviction: Guilty Sentence: 10 days in jail iist rhz :ames ar.d resi; er.ces of three �rse�s oi good monl chasactsr, living witY:in the Twin Cities Metro Area, not retated to tiie applicant or financiaily interested in the premises or business, who may be referred to as to the appiicanYs character: NAiv� Rar1 Brogxen Jim Schaetzel Bill Shappel ADDRESS 9376 I3 SSth St. Lake Elmo, MN 55042 3933 Bellaire White Bear Lk MN 55110 363 Atwater St Pau1 MN 55117 List licenses which you currently hold, formerly held, or may have an interest in: Class "A" driver's license PHONE (612) 770-6002 (612) 407-8530 (612) 489-34�4 Have any of the above named Iicenses ever been revoked? _ YES X NO If yes, list the dates and reasons for revocation: Are you going to opente this business personally? First Namc h5ddle Initial X YES � NO If not, who will opernte it? (Maiden) LaSt Home Addrcss: Street Name City Stare Zip Date of B'vth Phone Number � � i-a5� Are you going to have a manager or assistan[ in this business? X ygS _ NO If the manager is not the same as the operator, �� pleue complete the following information: Shannon M. Klisch 0'Brien March 30, 1969 Fiist Name IrLddie Initia! (Maidrn) lasc Datc of Hitth 1957 Wilson Avenue Apartment 303 St. Paul MN 55119 (612)702-99� tfome qamess: Sueet Nmne Statc Zip _ _ -- Phonc Num6es Cay Please list your employment history for the previous five (5) yeaz period: BusinessfEmnlovment Address 02/94 - now J P Automotive (Se nemp oye ue o (1R79� _ n619'i C„1,,,+7,�„ r��. rco 933 Atlantic St. St. Paul MN au accz en owner operator) St. Paul MN 04/92 - O8{92 Wright Tree Service Man ato MN ��8��t9�—�a�rarbg� 6ab �ea$c�s MN OS191 - 09)91 Wri ht Tree Service Mankato MN 11/90 - OS/91 Timberline Tree Service St. Pau List al] other officen of the corgoration: OFFICER TITLE HOME NAME (Office Aeld) ADDRESS 23ot Applicable....... HOME HUSR?ESS BATE OF PIiONE PHONE BIRTH If business is a parmership, please include the following information for each pamier (use additionai pages if necessary): Not Applicable....... F'ust Name Middle Inrosi (Maidtn) Las[ Date of Birth . Aome Addrcss: Street Name �--� � Cih - -' Siau - 7 Phone Number First Name Middle Initial (Maiden) Last Date of Buth Aomc Addttss: Street Name C7ty State Zip Phone Number MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant w the Laws of Minnesota, 1984, Chapter 502, Article 8, Secaon 2 (270.72) (Ta�; Cleazance; Issuance ofLicenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tas identification number and the social security number of each license applicant. Under the Minnesota Govemment Data Practices Act and t6e Fedeml Privacy Act of 1974, we are required to advise you of the following regarding the use of t6e Minnesota Tax Identification Number. - This information may be used to deny the issuance or renewal of your license in the event you owa Minnesota sales, employer's withholding or motor vehicle eaccise tases; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Informarion Agreement, the Depamnent of Revenue may supply this information to the Internai Revenue Service. Minnesota Tax Identification Numbers (Sales & L3se Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6181). Social SecurityNumber: 477-70-ki42 Minnesota Tax Identification Number: 139-7331 � _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by p}acing an "X" in the tiox. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 `��1 �-, E �' ` �', t ('?` � i Presented By Referred To Committee: Date RSSOLVED: That application, ID #14435, Por a new Auto Repair Garage License by J.P. Automotive DsA J.P. Automotive (Jeffrey Phillip O•Brien) at 933 Atlantic Street #2, be and the is hereby approved. Requested by Department of: Adopted by Adoption �e i � By: ��/ Approved by Council File # �� — � 5 � RESOLUTiON CITY OF SAINT PAUL, MINNESOTA �� Ordinance # Green Sheet # 35439 5� Secretary Date �S/ } Bys �- - • - -�_- :=.- .�_ _,. , •��,-� - ., BY% / T ""'<C�.� Form Approved by City Attorney BY � J .li✓�-� � Approved by Mayor for Submission to Council By: /+ . + D LIEP NT/OFFICHCOUNCIL DATE INRIATED �REEN SHEE N_ 3 5 4 3 9 CANiACT PERSON 8 PXON INRIALNA7E INITIAUDATE O DEPAqTMEM DIRECTOR O CRY COUNCiI Christine Rozek - 266-9108 ASS�GN �CRVATfORNEY �CRYCLERK NUMBEHiON MUST BE ON COUNCIL AGENDA BY (DAT� ) R�� BUOGEf �IflECTOR � FlN. 8 MGT. SEHVICES DIR. Hearing: 3 ��a��7 OROQt ��ypypR{pRAS$ISTANT) Q TOTAL # OF SIGNATURE PAGES � (CLIP ALL LOCATIONS FOR SiGNATURE) AC7ION fiEQUESTED: J.P. AutomoYive DBA J.P. Automotive (Jef£rey Phi3.lip 0'Brien) at 933 Atlantic Street #2 requests Council approval of a new Auto Repair Garage License. (ID 9{14435) PECOMMENDATIONS: Approve (n) or Reject (R) pER50NAL SERVICE CONTRACTS MUSTANSWER TNE fOLLOWING �UESTIONS: _ PLANNING COMMISSION _ qVll SERVICE CAMNASSION �� Has Mis persoNfirm ever worked under a contract for Mis deparhneM? - _CIB((bMMfTTEE _ YES "NO _ STAFF 2. Has Mis personflirm ever been a city empbyee? — YES NO — a��T �RT — 9. Daes [h1s personlFirtn possess a skAl not normal � ry possessed by any currem ciry employee. SUPPORTSWHICHCOUNC�LOBJECTIVE? YES NO Ezplain all yes answers on separete sheet anA attaoh W green sheet INITIATING PROBLEM. ISSUE, OPPORTUNITY (Who, NTet, When. Where, Why): � ADYANTAGES IF APPROVEO; DISADVANTAGES IFAPPHOVED: DISADVANTAGES IF NOTAGPROVED: v s , �$s[M . � `�_% �. �? '.��7 TOTAL AMOUNT OF TRANSACTION S COST7REYENUE BUDGETEO (GIRCIE ONE) YES NO FUNDIHG SOUpCE ACTIVITY NUMBER ' FINANCIAI INF�RMATION: (EXPLAIN) � Greensheet # 35439 L.I.E.P. REVIEW CHECKLIST Date: / Ifl TraCkef.�_� !� nPP'n Rec;eived / APP'n Processed q� a�8 License ID # 14435 License Type: Auto Repair caragP COmpany Name: J.P. Automotive DBA: J. P. Automotive Business Addresss: 933 Atlantic Street �t2 Business Phone: 772-2735 Contact Name/ Date to Councii Public Hearing Notice Sent to , lip 0'Brien Home Phone: 702— 2 Ave. 4�303 55119 'v `,�rs-• f �i C� � Labels Ordered: � �} District CoUnal #: 04 Notice Sern to Pubiic: Ward #: 06 DepartmentJ Date lnspeetions Comments City Attomey �'�'��" Environmental Health 2•5•9�- �}.� . Fire 2-'�J+�t�" C�•� • LIC2Ils8 Site Plan Received:_ Leese Received: ��,� J �� %--� Police 2 •5''°t�- �.� . Zoning 2,� 0.�, . . .. ��-�� 35 �� y� �'4� � ' '''�' �� CLASS III CTTY OF SAINT PAUL d �' � `r .��. ``' !.. i � ? O�ce of License. Inspcctions LICENSE APPLICATION �„a E,,, r��o„ JAff ! 3 9 43 �� '91 130 Sc Pes¢ $c Sui�e 300 Sain� Au�. Mimmu ,5�01 (613) 26&9090 fa (612) 3669124 THIS APPLICATION IS SUBJECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT IN INK Type of License being applied for: Busiaess RL1TpMOTI V� (�EPRI I� — GENE��-�- Company Name: J P Automotive Coryoruion / Paimaship / Sok Prop=ietoiship If business is incorporeted, give date of inco:pontion: _ Doing Business As: J P Automotive Business Phone: C612) 772-2738 BusinessAddress: 433 Atlantic St Unit 2 St. Paul MN 55106 •� Streec Addsess City State Zip Between what cross streets is the business located? Atlantic and Duluth Which side of the street? West Are the premises now occupied? YeS What ofBusiness? Automotive repair Mail To Address: 933 Atlantic St Unit 2 St. Paul MN 55106 Shee[ Address City Smte Zip Applicant Information: Name and Tiile: Seffrey Phillip 0'Brien Owner First " 2vLddle (Maiden) Lasc Title HomeAddress: 1957 WiZson Avenue Apartment 303 St. Paul MI3 55119 Stree[ Abdress Ciry State �p DateofBirth: December 28, 1956 placeofBirth: International Fa11 HomePhone: t612� 702-9923 y � Yes Minnesota Are ou a citizen of the United States? Native. Naturalized? --- If you are not a U.S. citizen, you must have work authorization from the U.S. Immigration & Naturalization Service. Have. you ever been convicted of any felony, crime or violation of any city ordinance other than traffic? YES X NO _ Dateofarsest: Unsure (1986???) Where? Rock Springs, Wyoming Chazge: Assault Conviction: Guilty Sentence: 10 days in jail iist rhz :ames ar.d resi; er.ces of three �rse�s oi good monl chasactsr, living witY:in the Twin Cities Metro Area, not retated to tiie applicant or financiaily interested in the premises or business, who may be referred to as to the appiicanYs character: NAiv� Rar1 Brogxen Jim Schaetzel Bill Shappel ADDRESS 9376 I3 SSth St. Lake Elmo, MN 55042 3933 Bellaire White Bear Lk MN 55110 363 Atwater St Pau1 MN 55117 List licenses which you currently hold, formerly held, or may have an interest in: Class "A" driver's license PHONE (612) 770-6002 (612) 407-8530 (612) 489-34�4 Have any of the above named Iicenses ever been revoked? _ YES X NO If yes, list the dates and reasons for revocation: Are you going to opente this business personally? First Namc h5ddle Initial X YES � NO If not, who will opernte it? (Maiden) LaSt Home Addrcss: Street Name City Stare Zip Date of B'vth Phone Number � � i-a5� Are you going to have a manager or assistan[ in this business? X ygS _ NO If the manager is not the same as the operator, �� pleue complete the following information: Shannon M. Klisch 0'Brien March 30, 1969 Fiist Name IrLddie Initia! (Maidrn) lasc Datc of Hitth 1957 Wilson Avenue Apartment 303 St. Paul MN 55119 (612)702-99� tfome qamess: Sueet Nmne Statc Zip _ _ -- Phonc Num6es Cay Please list your employment history for the previous five (5) yeaz period: BusinessfEmnlovment Address 02/94 - now J P Automotive (Se nemp oye ue o (1R79� _ n619'i C„1,,,+7,�„ r��. rco 933 Atlantic St. St. Paul MN au accz en owner operator) St. Paul MN 04/92 - O8{92 Wright Tree Service Man ato MN ��8��t9�—�a�rarbg� 6ab �ea$c�s MN OS191 - 09)91 Wri ht Tree Service Mankato MN 11/90 - OS/91 Timberline Tree Service St. Pau List al] other officen of the corgoration: OFFICER TITLE HOME NAME (Office Aeld) ADDRESS 23ot Applicable....... HOME HUSR?ESS BATE OF PIiONE PHONE BIRTH If business is a parmership, please include the following information for each pamier (use additionai pages if necessary): Not Applicable....... F'ust Name Middle Inrosi (Maidtn) Las[ Date of Birth . Aome Addrcss: Street Name �--� � Cih - -' Siau - 7 Phone Number First Name Middle Initial (Maiden) Last Date of Buth Aomc Addttss: Street Name C7ty State Zip Phone Number MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant w the Laws of Minnesota, 1984, Chapter 502, Article 8, Secaon 2 (270.72) (Ta�; Cleazance; Issuance ofLicenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tas identification number and the social security number of each license applicant. Under the Minnesota Govemment Data Practices Act and t6e Fedeml Privacy Act of 1974, we are required to advise you of the following regarding the use of t6e Minnesota Tax Identification Number. - This information may be used to deny the issuance or renewal of your license in the event you owa Minnesota sales, employer's withholding or motor vehicle eaccise tases; - Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Informarion Agreement, the Depamnent of Revenue may supply this information to the Internai Revenue Service. Minnesota Tax Identification Numbers (Sales & L3se Tax Number) may be obtained from the State of Minnesota, Business Records Department, 10 River Park Plaza (612-296-6181). Social SecurityNumber: 477-70-ki42 Minnesota Tax Identification Number: 139-7331 � _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by p}acing an "X" in the tiox.