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97-516g Council File # � S` �f � � i �'� � ; f '� t � ` � � � t `., ;°-� y Ordinance # Green Sheet # �� Presented By Referred To 1 RESOLVED: That application (1D #22082) for a Wine On Sale and On Sale Malt (Strong Beer) License by 2 Saykham Seagmavong DBA Family LaaThai Restaurant (Saykham Sengmavong, Owner) at 501 3 Univessity Avenue West be and the same is hereby approved. 4 5 Requested by Department of: 6 e Nava Absent 7 B a ey 8 Bostrom Off�ce of L�cenae InspQetions and 9 r Har i 10 M ard EnvirorLmental Protection 11 12 2' une 13 -tn , ��.'�-� "v""' � ' v/ . 14 � � 15 16 Adopted by Council: Date ��"� B y' ' 17 18 Adoption Certified by Council Se tary 19 Form Approved by City Attorney 20 �� 21 By: 22 j 23 Apptoved byAMa Date �` 24 �� 25 ��1��0� Approved by Mayor for Submisaion to 26 BY: �/� fi Council 27 Bye RESOLUTION CITY OF SAtNT PAUL, MlNNESOTA '�� q'1•SIL OEPAi7�MENT/pFFICFJCOUNCIL DATEINRIATED GREEN SHEE N_ 35302 LIEP/Licensin - -- CANTACT PEp$ON & PHONE �NITIAIJDATE INITIAWATE a DEPARiMENT DIRECTOR � GRY CAUNCIL Christine Rozek, 266-9108 "��" �CRYATTOBNEY �CRYGFRK MUST BE ON COUNCIL AGENOA BY OATE) p�� BU�('iEC OIRECfOR O FIN. & MIGT. SERVICES OIR. For hearin : 7��7 oaoEa ❑""'v°E' c°a'�ss�s'um � TOTAL # OF SIGNATURE PA6ES (CLIP ALL LOCATIONS FOR S16NATURE) ACfION fiEWESTED: Saykham Sangmavong DBA Family Lao-Thai Restaurant requests Council approval of its application for a Wine On Sale and On Sale Malt (Strong Beer) License located at 501 University Avenue West (ID �/22082). RECOMMENOAnOFIS: npprwe (a) or Reject (R1 pERSONAL SEiiViCE CONTRACTS MUST ANSWER TXE FOLLOWING UUESTIONS: _ PLANNING COMMISSION _ CNIL SERVICE COMMISSION �� Has Uis personffirm ever worketl under a contract for this departmeM? - _ ��B C�MfrtEE _ YES NO —�� — 2. Has Mis perso�rm ever been a ciry employee? � YES NO _ DISiRICiCOURT _ 3. poes Mis persOnHirm pos5e5s a skill not normaily possessetl by any current ctity em I ee? Pq' SUPPORTSWHICHCAUNCILaBJECTIVE? YES NO ExpLain all yes enswen on separete sheet snd attaeh to green shaet IPIITIATING PpOgLEM. ISSLLE. OPPORTUNITY (Who. Whet. Wlian, Whe�e. WhY): RECEiVED RECf��#� MAR 3 1 19g7 1 � R � Y �� f�� 2a 1997 ADVANTAGES IFAPPROVED: DISA�VANTAGES IFAPPROVED: ,�5�3 �aaa�f?.�B �,�'� �'r�� aw�� DISADVANTAC+ESIFNOTAPPROVED: -'-°° � ` _'.�.;;..�.�..� ,,, T07AL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETEp (CIRCLE ONE) YES NO FUNDING SOURCE ACTMTY NUMBEH FINANCIAL INFORMATION: (EXPLAIN) �reensheet# 35302 L.I.E.P. REVIEW CHECKLIST Date: 2/19/97 /�7js��/ tn Tfilckef? APP'n �rv� 1 APP'n P�°cessetl License ID # 22�82 LicenSeType: Wine On Sale and On Sale Malt (Strang R�PrI Company Name: Saykham Sengmavong DBA: Familv Lao-Thai Restaurant Business Addresss: 501 Universitv Avenue Wese 8usineSS Phone: ContactName/AddresS: Savkham Sengmavong. 1124� Utica St Home Phone: 888-4059 Date to Council Research: Bloomington MN 55437 ��/ �G�s�.�3D��g Pubtic Hearing Date: � � �� Notice Sent to Applican��7�% � �; _ �.� Labels Ordered: Z-25-97 Districi Councii #: / � `l'"/ JYf, � .> v Notice Sentto Public: � �� Ward #: � Departmentj Date Inspections Comments City Attorney . � � • � �" � •�', • Environmentaf Heatth 3�11��- O•�• Fire � . 2 '� -�- p. . License �� an �� Lease aeceived: � �. f �� 1 a � 6t� Potice � . � l-`��- �.� . Zoning 3 •L1 •Q �-- O• 1� . T}pe of Lice;ise(s) being applied for: �fR cLASSUl cirYOFSn�-�r� S1(. �ce of LicensS Inspectians LICENSE APPLICATION �dEn.vomnrnlalProteciion 3_4 SL Pqc SL Sw�e 300 Ss'vaPaut\famcota 35101 (6I])166Y,W0 fix(611)166?12< P�- �� THIS APPLICATION IS SUBTECT TO REV�W BY THE PUBLIC PLEASE i YPE OR PRIIdT IN INK o2,� lr r.._ c A_ B.'1_�._ ,. C�� Company Name: Y"u m i(_� L.6ti� -- 1�nc.. � v.Y4 +n . yi�r r. r s Proprieloiship If business is incorporated, gi��e Doing Business As: Business Address: SU � Business Phone: , vJ _ S'�' -��ti.� I'�I � S� / t7 s�� naa� --- — c�h s�c� z�y Betw�een what cross sVeeu is the business located? Ul 1/� t<!�`� 1�— M°1.LK+.�. t� "h'i'C1�i side of the street? Y� G�t Are the premises nou' occupied? VJhat T}'p�e of Business? �'�'��xMYC� °� Mai] To Address: 5l� f L� � i'`� i''�- �'c� �v� - VJ C"f_ �/�-� L /� ,i�/ s ( O'3 Sl+ect Addrne Ciry' S�nte Zip Applicant Information: � N�e �a r��: s,�� t<fr-�.�-� _ s�r�sm.�v�>sC- Fint .V.'�ddic (l�faidrn) / I,ast Tiqe Home Address: �� .r �'+-�� -S ��.o:�;>t »f /�/V �$ j�J � S�rectAddre � City T State Zip Date of Buth: 0`' 0� C� t7 place of Birth: ��-L-Z' � Home Phone: S��'' Z�n.S�'J Have }'ou e��er been com�icted of anV felonc, crime or vio]ation of any city ordinance other than traffic? YES _ NO �� Date of azrest Vlhere7 Charge: Cam'tction: Sentrnce: List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, �rho may be referred to as to the applicant's character: List licenses lchich you currenllp hold, formerly held, or map hace an interest in: Ha��e any� of ihe above named licenses e�er been revoked? YES NO If }�es,list ihe dates and reasons for rel•ocation: 2:18�97 Are �ou going to operate this business personally? �XES First �'ame \liddlc (�Saidrn) HomeAddrtts: Sveet�emc Cih' Are }rou going to ha�'e a manager or assistant in this business? (/� YES piease comp:ete the folloti�ing informalion: NO If not, �rho t�711 operate it? I.ad State \ 5 ' �' C+Q 7 � '+`'� a1'S�g �`cs y 4 ti�.�`` ro Dm� otBb�,��'� `�� O �� PLane�umba � Q� Q NO If the manager is not the same as the operamr, ,\ Finl1�'�e ��liddlcIttitial (Vaidn) Last DateofBirth \ Homc.4ddzns: Sttcet�ame CiR' Please list your emplo�ment history for the previous fice (5) }'eaz period: Business/Emolo�ment Address List all other officers of the corporation: OFFICER TITLE HOME I��AME (Office Held) ADARESS State Zip Pfione\umber HOME BUSII�'ESS PH02�'E PHONE DATE OF BIIZTH If business is a partnership, please inc3ude the follow�ing information for each partner (use additianal pages if necessaz}): Fvst \ame Home Address: $Uett �emc F;r.i xamo x�,� naa.�: sc,ttt �,n,� Middlc Initisl ?vSiddie Initisl (�laidrn) City (�laidcn) Ciry I.ari Sta[e Zip Lasc Statc Zip Datc of Birih Phone �umbcr Date aCBirth Phone humber MINNF..SOTA TAX IAENI IFICATION NiIMBER - Putsuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section Z(270J2) (Ta� Clearance; Issuance of Licenses), licensing authorities are required (o pro��ide to the State of Minnesota Comtnissioner of Re� enue, the Minnewta business tax ident�cation number and the social secunty number of each ]icense applicant. Under the Mitmesota Govemment Data Practices Act and the Federa] Privacy Act of 1974, we are required to ad��se you of the follo«�ing rcgarding [he use of the Minnesota Ta� Identification Number: - This informaUon may be used to deny the issuance or reneH�al of }'our license in the event }'ou o�+�e Minnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authoriry u'ill supply it only to the Minnesota Depariment of Revrnue However, under the Federal Exchange of InfoRnation Agreemrnt, the Department of Re��enue may suppl}' this information to the Interna] Reeenue Sen•ice. Minnesota Tav Identification Numbers (Sales & Use Tax Number) ma}' be ob[ained from the Siate of Minneso[a, Business Records Depaztment 10 Ri��er Puk Plaza (67 2-296-63 81). Social Security Number: �� O G"' 7a l� Minnesota Tax Identifrcation Number; _ If a Minnesota Tas idrnUfication Number is not requirzd for the business being operated, indticate so 6}' p�acing an"X" dn the box. ` 2 7 8'97 L r CATION OF V�'ORKERS' COMPENSATION C0�'ERAGE PURSUANI TO MINNESOTA STANTE 176.182 9�-s�� eby certif) that I, or m}' company, am in compliance u�th the n%�:ers' compensation insurance w�'erage requiremen�s of Minnesota Statute 182, subdi� 2. I also understand that pro�zsian of false info: mation in this certiiication constitutes s�cient grounds for ad��erse aclion �st all licenses held, inciuding re��ocauon and suspension of said licenses. Narne of Inswance Compan} �� r i G�� :-� y�'i "" 1�-e/ . Policy Number: Co��erage from // f i to ��.1 �G 7- I ha��e no emplo}'ees co�'ered under «orkers wmpensation insurance S- S(AZTIALS) Ai�'1' FALSIFICATION OF ANSV1'ERS GIVEN OR MATERIAL SUBMTI'fED ♦VILL RESULT II3 DErTAL OF THIS APPLICATION i hereby siate that I hace anstcered a11 of the preceding questions, and that the information contained herean is true and correct to the best of my kno��•ledge and belief. I hereby stzte further that I have receiced no money or ocher consideralion, by �'ay of loan, gift, contribution, or othuuise, other than atready disclosed in the application u3uch I haeuith submitted I also understand this preatise ma}' be inspecied b}' police, fire, health and other cit}• officials at an}� and all times u�hen the business is in operaaon. �//b' for all applications) We ni(1 accept payment b}' cash, check (made payable to Cih� of Saint Paul) or credit card (M/C or Visa). �� 7 Aate IF PAYING BY CREDIT CA 8D PLEASE COMPLPTE THE FOLLOWING7R'FORMATION: � MasierCard � Visa EXPIRATION DATE: �= G7�9 s,�y� \ame of CarAiolder sm •*Note: If ihis application is FoodlLiquos related, please contact a Citp of Saint Paui Health Inspector, Steve Olson (266-9139), lo review plans. If an}' substantia] changes to structure are anticipated, please wntact a Citp of Saint Paul Plan Esaminer at 266-9007 to appt}' for building pemuts If there aze an} changes to Ihe parking ]ot, floor space, or for ne«� operations, please contact a City of Saint Paui Zoning Inspector at 266-9008. All applications require the foUoning documents. Piease attach these documents when submitting your appiication: l. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The follo�3ing data should be on the site plan (preferably on an 8 U2° x l 1" or 8 7/2" x 14" paper): - Name, address, and phone number. - The sca]e should be stated such as 1" = ZO'. ^N should be indicated to«�azd the top. - Placement of all pertinent features of the interior of the licensed faciliry such as seating azeas, kitchens, offices, repa'u area, pazking, rest rooms, etc. - If a request is for an addition or eapansion of the licensed facility, indicate both the curreqt azea and the proposed expansion. 2. A copy of }'ow lease agreement or proof of ownership of the property. SPECIFIC LICENSE A.PPLICATIONS REQUIItE ADDTTIONAL INFORNLITION. PLEASE SEE REVERSE FOR DETAILS >>>> ACCOUM NIIMBER: '!��=lm �30T�1 �/�L�C; �3�1�6 �.v :'� s�9� g Council File # � S` �f � � i �'� � ; f '� t � ` � � � t `., ;°-� y Ordinance # Green Sheet # �� Presented By Referred To 1 RESOLVED: That application (1D #22082) for a Wine On Sale and On Sale Malt (Strong Beer) License by 2 Saykham Seagmavong DBA Family LaaThai Restaurant (Saykham Sengmavong, Owner) at 501 3 Univessity Avenue West be and the same is hereby approved. 4 5 Requested by Department of: 6 e Nava Absent 7 B a ey 8 Bostrom Off�ce of L�cenae InspQetions and 9 r Har i 10 M ard EnvirorLmental Protection 11 12 2' une 13 -tn , ��.'�-� "v""' � ' v/ . 14 � � 15 16 Adopted by Council: Date ��"� B y' ' 17 18 Adoption Certified by Council Se tary 19 Form Approved by City Attorney 20 �� 21 By: 22 j 23 Apptoved byAMa Date �` 24 �� 25 ��1��0� Approved by Mayor for Submisaion to 26 BY: �/� fi Council 27 Bye RESOLUTION CITY OF SAtNT PAUL, MlNNESOTA '�� q'1•SIL OEPAi7�MENT/pFFICFJCOUNCIL DATEINRIATED GREEN SHEE N_ 35302 LIEP/Licensin - -- CANTACT PEp$ON & PHONE �NITIAIJDATE INITIAWATE a DEPARiMENT DIRECTOR � GRY CAUNCIL Christine Rozek, 266-9108 "��" �CRYATTOBNEY �CRYGFRK MUST BE ON COUNCIL AGENOA BY OATE) p�� BU�('iEC OIRECfOR O FIN. & MIGT. SERVICES OIR. For hearin : 7��7 oaoEa ❑""'v°E' c°a'�ss�s'um � TOTAL # OF SIGNATURE PA6ES (CLIP ALL LOCATIONS FOR S16NATURE) ACfION fiEWESTED: Saykham Sangmavong DBA Family Lao-Thai Restaurant requests Council approval of its application for a Wine On Sale and On Sale Malt (Strong Beer) License located at 501 University Avenue West (ID �/22082). RECOMMENOAnOFIS: npprwe (a) or Reject (R1 pERSONAL SEiiViCE CONTRACTS MUST ANSWER TXE FOLLOWING UUESTIONS: _ PLANNING COMMISSION _ CNIL SERVICE COMMISSION �� Has Uis personffirm ever worketl under a contract for this departmeM? - _ ��B C�MfrtEE _ YES NO —�� — 2. Has Mis perso�rm ever been a ciry employee? � YES NO _ DISiRICiCOURT _ 3. poes Mis persOnHirm pos5e5s a skill not normaily possessetl by any current ctity em I ee? Pq' SUPPORTSWHICHCAUNCILaBJECTIVE? YES NO ExpLain all yes enswen on separete sheet snd attaeh to green shaet IPIITIATING PpOgLEM. ISSLLE. OPPORTUNITY (Who. Whet. Wlian, Whe�e. WhY): RECEiVED RECf��#� MAR 3 1 19g7 1 � R � Y �� f�� 2a 1997 ADVANTAGES IFAPPROVED: DISA�VANTAGES IFAPPROVED: ,�5�3 �aaa�f?.�B �,�'� �'r�� aw�� DISADVANTAC+ESIFNOTAPPROVED: -'-°° � ` _'.�.;;..�.�..� ,,, T07AL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETEp (CIRCLE ONE) YES NO FUNDING SOURCE ACTMTY NUMBEH FINANCIAL INFORMATION: (EXPLAIN) �reensheet# 35302 L.I.E.P. REVIEW CHECKLIST Date: 2/19/97 /�7js��/ tn Tfilckef? APP'n �rv� 1 APP'n P�°cessetl License ID # 22�82 LicenSeType: Wine On Sale and On Sale Malt (Strang R�PrI Company Name: Saykham Sengmavong DBA: Familv Lao-Thai Restaurant Business Addresss: 501 Universitv Avenue Wese 8usineSS Phone: ContactName/AddresS: Savkham Sengmavong. 1124� Utica St Home Phone: 888-4059 Date to Council Research: Bloomington MN 55437 ��/ �G�s�.�3D��g Pubtic Hearing Date: � � �� Notice Sent to Applican��7�% � �; _ �.� Labels Ordered: Z-25-97 Districi Councii #: / � `l'"/ JYf, � .> v Notice Sentto Public: � �� Ward #: � Departmentj Date Inspections Comments City Attorney . � � • � �" � •�', • Environmentaf Heatth 3�11��- O•�• Fire � . 2 '� -�- p. . License �� an �� Lease aeceived: � �. f �� 1 a � 6t� Potice � . � l-`��- �.� . Zoning 3 •L1 •Q �-- O• 1� . T}pe of Lice;ise(s) being applied for: �fR cLASSUl cirYOFSn�-�r� S1(. �ce of LicensS Inspectians LICENSE APPLICATION �dEn.vomnrnlalProteciion 3_4 SL Pqc SL Sw�e 300 Ss'vaPaut\famcota 35101 (6I])166Y,W0 fix(611)166?12< P�- �� THIS APPLICATION IS SUBTECT TO REV�W BY THE PUBLIC PLEASE i YPE OR PRIIdT IN INK o2,� lr r.._ c A_ B.'1_�._ ,. C�� Company Name: Y"u m i(_� L.6ti� -- 1�nc.. � v.Y4 +n . yi�r r. r s Proprieloiship If business is incorporated, gi��e Doing Business As: Business Address: SU � Business Phone: , vJ _ S'�' -��ti.� I'�I � S� / t7 s�� naa� --- — c�h s�c� z�y Betw�een what cross sVeeu is the business located? Ul 1/� t<!�`� 1�— M°1.LK+.�. t� "h'i'C1�i side of the street? Y� G�t Are the premises nou' occupied? VJhat T}'p�e of Business? �'�'��xMYC� °� Mai] To Address: 5l� f L� � i'`� i''�- �'c� �v� - VJ C"f_ �/�-� L /� ,i�/ s ( O'3 Sl+ect Addrne Ciry' S�nte Zip Applicant Information: � N�e �a r��: s,�� t<fr-�.�-� _ s�r�sm.�v�>sC- Fint .V.'�ddic (l�faidrn) / I,ast Tiqe Home Address: �� .r �'+-�� -S ��.o:�;>t »f /�/V �$ j�J � S�rectAddre � City T State Zip Date of Buth: 0`' 0� C� t7 place of Birth: ��-L-Z' � Home Phone: S��'' Z�n.S�'J Have }'ou e��er been com�icted of anV felonc, crime or vio]ation of any city ordinance other than traffic? YES _ NO �� Date of azrest Vlhere7 Charge: Cam'tction: Sentrnce: List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, �rho may be referred to as to the applicant's character: List licenses lchich you currenllp hold, formerly held, or map hace an interest in: Ha��e any� of ihe above named licenses e�er been revoked? YES NO If }�es,list ihe dates and reasons for rel•ocation: 2:18�97 Are �ou going to operate this business personally? �XES First �'ame \liddlc (�Saidrn) HomeAddrtts: Sveet�emc Cih' Are }rou going to ha�'e a manager or assistant in this business? (/� YES piease comp:ete the folloti�ing informalion: NO If not, �rho t�711 operate it? I.ad State \ 5 ' �' C+Q 7 � '+`'� a1'S�g �`cs y 4 ti�.�`` ro Dm� otBb�,��'� `�� O �� PLane�umba � Q� Q NO If the manager is not the same as the operamr, ,\ Finl1�'�e ��liddlcIttitial (Vaidn) Last DateofBirth \ Homc.4ddzns: Sttcet�ame CiR' Please list your emplo�ment history for the previous fice (5) }'eaz period: Business/Emolo�ment Address List all other officers of the corporation: OFFICER TITLE HOME I��AME (Office Held) ADARESS State Zip Pfione\umber HOME BUSII�'ESS PH02�'E PHONE DATE OF BIIZTH If business is a partnership, please inc3ude the follow�ing information for each partner (use additianal pages if necessaz}): Fvst \ame Home Address: $Uett �emc F;r.i xamo x�,� naa.�: sc,ttt �,n,� Middlc Initisl ?vSiddie Initisl (�laidrn) City (�laidcn) Ciry I.ari Sta[e Zip Lasc Statc Zip Datc of Birih Phone �umbcr Date aCBirth Phone humber MINNF..SOTA TAX IAENI IFICATION NiIMBER - Putsuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section Z(270J2) (Ta� Clearance; Issuance of Licenses), licensing authorities are required (o pro��ide to the State of Minnesota Comtnissioner of Re� enue, the Minnewta business tax ident�cation number and the social secunty number of each ]icense applicant. Under the Mitmesota Govemment Data Practices Act and the Federa] Privacy Act of 1974, we are required to ad��se you of the follo«�ing rcgarding [he use of the Minnesota Ta� Identification Number: - This informaUon may be used to deny the issuance or reneH�al of }'our license in the event }'ou o�+�e Minnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authoriry u'ill supply it only to the Minnesota Depariment of Revrnue However, under the Federal Exchange of InfoRnation Agreemrnt, the Department of Re��enue may suppl}' this information to the Interna] Reeenue Sen•ice. Minnesota Tav Identification Numbers (Sales & Use Tax Number) ma}' be ob[ained from the Siate of Minneso[a, Business Records Depaztment 10 Ri��er Puk Plaza (67 2-296-63 81). Social Security Number: �� O G"' 7a l� Minnesota Tax Identifrcation Number; _ If a Minnesota Tas idrnUfication Number is not requirzd for the business being operated, indticate so 6}' p�acing an"X" dn the box. ` 2 7 8'97 L r CATION OF V�'ORKERS' COMPENSATION C0�'ERAGE PURSUANI TO MINNESOTA STANTE 176.182 9�-s�� eby certif) that I, or m}' company, am in compliance u�th the n%�:ers' compensation insurance w�'erage requiremen�s of Minnesota Statute 182, subdi� 2. I also understand that pro�zsian of false info: mation in this certiiication constitutes s�cient grounds for ad��erse aclion �st all licenses held, inciuding re��ocauon and suspension of said licenses. Narne of Inswance Compan} �� r i G�� :-� y�'i "" 1�-e/ . Policy Number: Co��erage from // f i to ��.1 �G 7- I ha��e no emplo}'ees co�'ered under «orkers wmpensation insurance S- S(AZTIALS) Ai�'1' FALSIFICATION OF ANSV1'ERS GIVEN OR MATERIAL SUBMTI'fED ♦VILL RESULT II3 DErTAL OF THIS APPLICATION i hereby siate that I hace anstcered a11 of the preceding questions, and that the information contained herean is true and correct to the best of my kno��•ledge and belief. I hereby stzte further that I have receiced no money or ocher consideralion, by �'ay of loan, gift, contribution, or othuuise, other than atready disclosed in the application u3uch I haeuith submitted I also understand this preatise ma}' be inspecied b}' police, fire, health and other cit}• officials at an}� and all times u�hen the business is in operaaon. �//b' for all applications) We ni(1 accept payment b}' cash, check (made payable to Cih� of Saint Paul) or credit card (M/C or Visa). �� 7 Aate IF PAYING BY CREDIT CA 8D PLEASE COMPLPTE THE FOLLOWING7R'FORMATION: � MasierCard � Visa EXPIRATION DATE: �= G7�9 s,�y� \ame of CarAiolder sm •*Note: If ihis application is FoodlLiquos related, please contact a Citp of Saint Paui Health Inspector, Steve Olson (266-9139), lo review plans. If an}' substantia] changes to structure are anticipated, please wntact a Citp of Saint Paul Plan Esaminer at 266-9007 to appt}' for building pemuts If there aze an} changes to Ihe parking ]ot, floor space, or for ne«� operations, please contact a City of Saint Paui Zoning Inspector at 266-9008. All applications require the foUoning documents. Piease attach these documents when submitting your appiication: l. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The follo�3ing data should be on the site plan (preferably on an 8 U2° x l 1" or 8 7/2" x 14" paper): - Name, address, and phone number. - The sca]e should be stated such as 1" = ZO'. ^N should be indicated to«�azd the top. - Placement of all pertinent features of the interior of the licensed faciliry such as seating azeas, kitchens, offices, repa'u area, pazking, rest rooms, etc. - If a request is for an addition or eapansion of the licensed facility, indicate both the curreqt azea and the proposed expansion. 2. A copy of }'ow lease agreement or proof of ownership of the property. SPECIFIC LICENSE A.PPLICATIONS REQUIItE ADDTTIONAL INFORNLITION. PLEASE SEE REVERSE FOR DETAILS >>>> ACCOUM NIIMBER: '!��=lm �30T�1 �/�L�C; �3�1�6 �.v :'� s�9� g Council File # � S` �f � � i �'� � ; f '� t � ` � � � t `., ;°-� y Ordinance # Green Sheet # �� Presented By Referred To 1 RESOLVED: That application (1D #22082) for a Wine On Sale and On Sale Malt (Strong Beer) License by 2 Saykham Seagmavong DBA Family LaaThai Restaurant (Saykham Sengmavong, Owner) at 501 3 Univessity Avenue West be and the same is hereby approved. 4 5 Requested by Department of: 6 e Nava Absent 7 B a ey 8 Bostrom Off�ce of L�cenae InspQetions and 9 r Har i 10 M ard EnvirorLmental Protection 11 12 2' une 13 -tn , ��.'�-� "v""' � ' v/ . 14 � � 15 16 Adopted by Council: Date ��"� B y' ' 17 18 Adoption Certified by Council Se tary 19 Form Approved by City Attorney 20 �� 21 By: 22 j 23 Apptoved byAMa Date �` 24 �� 25 ��1��0� Approved by Mayor for Submisaion to 26 BY: �/� fi Council 27 Bye RESOLUTION CITY OF SAtNT PAUL, MlNNESOTA '�� q'1•SIL OEPAi7�MENT/pFFICFJCOUNCIL DATEINRIATED GREEN SHEE N_ 35302 LIEP/Licensin - -- CANTACT PEp$ON & PHONE �NITIAIJDATE INITIAWATE a DEPARiMENT DIRECTOR � GRY CAUNCIL Christine Rozek, 266-9108 "��" �CRYATTOBNEY �CRYGFRK MUST BE ON COUNCIL AGENOA BY OATE) p�� BU�('iEC OIRECfOR O FIN. & MIGT. SERVICES OIR. For hearin : 7��7 oaoEa ❑""'v°E' c°a'�ss�s'um � TOTAL # OF SIGNATURE PA6ES (CLIP ALL LOCATIONS FOR S16NATURE) ACfION fiEWESTED: Saykham Sangmavong DBA Family Lao-Thai Restaurant requests Council approval of its application for a Wine On Sale and On Sale Malt (Strong Beer) License located at 501 University Avenue West (ID �/22082). RECOMMENOAnOFIS: npprwe (a) or Reject (R1 pERSONAL SEiiViCE CONTRACTS MUST ANSWER TXE FOLLOWING UUESTIONS: _ PLANNING COMMISSION _ CNIL SERVICE COMMISSION �� Has Uis personffirm ever worketl under a contract for this departmeM? - _ ��B C�MfrtEE _ YES NO —�� — 2. Has Mis perso�rm ever been a ciry employee? � YES NO _ DISiRICiCOURT _ 3. poes Mis persOnHirm pos5e5s a skill not normaily possessetl by any current ctity em I ee? Pq' SUPPORTSWHICHCAUNCILaBJECTIVE? YES NO ExpLain all yes enswen on separete sheet snd attaeh to green shaet IPIITIATING PpOgLEM. ISSLLE. OPPORTUNITY (Who. Whet. Wlian, Whe�e. WhY): RECEiVED RECf��#� MAR 3 1 19g7 1 � R � Y �� f�� 2a 1997 ADVANTAGES IFAPPROVED: DISA�VANTAGES IFAPPROVED: ,�5�3 �aaa�f?.�B �,�'� �'r�� aw�� DISADVANTAC+ESIFNOTAPPROVED: -'-°° � ` _'.�.;;..�.�..� ,,, T07AL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETEp (CIRCLE ONE) YES NO FUNDING SOURCE ACTMTY NUMBEH FINANCIAL INFORMATION: (EXPLAIN) �reensheet# 35302 L.I.E.P. REVIEW CHECKLIST Date: 2/19/97 /�7js��/ tn Tfilckef? APP'n �rv� 1 APP'n P�°cessetl License ID # 22�82 LicenSeType: Wine On Sale and On Sale Malt (Strang R�PrI Company Name: Saykham Sengmavong DBA: Familv Lao-Thai Restaurant Business Addresss: 501 Universitv Avenue Wese 8usineSS Phone: ContactName/AddresS: Savkham Sengmavong. 1124� Utica St Home Phone: 888-4059 Date to Council Research: Bloomington MN 55437 ��/ �G�s�.�3D��g Pubtic Hearing Date: � � �� Notice Sent to Applican��7�% � �; _ �.� Labels Ordered: Z-25-97 Districi Councii #: / � `l'"/ JYf, � .> v Notice Sentto Public: � �� Ward #: � Departmentj Date Inspections Comments City Attorney . � � • � �" � •�', • Environmentaf Heatth 3�11��- O•�• Fire � . 2 '� -�- p. . License �� an �� Lease aeceived: � �. f �� 1 a � 6t� Potice � . � l-`��- �.� . Zoning 3 •L1 •Q �-- O• 1� . T}pe of Lice;ise(s) being applied for: �fR cLASSUl cirYOFSn�-�r� S1(. �ce of LicensS Inspectians LICENSE APPLICATION �dEn.vomnrnlalProteciion 3_4 SL Pqc SL Sw�e 300 Ss'vaPaut\famcota 35101 (6I])166Y,W0 fix(611)166?12< P�- �� THIS APPLICATION IS SUBTECT TO REV�W BY THE PUBLIC PLEASE i YPE OR PRIIdT IN INK o2,� lr r.._ c A_ B.'1_�._ ,. C�� Company Name: Y"u m i(_� L.6ti� -- 1�nc.. � v.Y4 +n . yi�r r. r s Proprieloiship If business is incorporated, gi��e Doing Business As: Business Address: SU � Business Phone: , vJ _ S'�' -��ti.� I'�I � S� / t7 s�� naa� --- — c�h s�c� z�y Betw�een what cross sVeeu is the business located? Ul 1/� t<!�`� 1�— M°1.LK+.�. t� "h'i'C1�i side of the street? Y� G�t Are the premises nou' occupied? VJhat T}'p�e of Business? �'�'��xMYC� °� Mai] To Address: 5l� f L� � i'`� i''�- �'c� �v� - VJ C"f_ �/�-� L /� ,i�/ s ( O'3 Sl+ect Addrne Ciry' S�nte Zip Applicant Information: � N�e �a r��: s,�� t<fr-�.�-� _ s�r�sm.�v�>sC- Fint .V.'�ddic (l�faidrn) / I,ast Tiqe Home Address: �� .r �'+-�� -S ��.o:�;>t »f /�/V �$ j�J � S�rectAddre � City T State Zip Date of Buth: 0`' 0� C� t7 place of Birth: ��-L-Z' � Home Phone: S��'' Z�n.S�'J Have }'ou e��er been com�icted of anV felonc, crime or vio]ation of any city ordinance other than traffic? YES _ NO �� Date of azrest Vlhere7 Charge: Cam'tction: Sentrnce: List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in the premises or business, �rho may be referred to as to the applicant's character: List licenses lchich you currenllp hold, formerly held, or map hace an interest in: Ha��e any� of ihe above named licenses e�er been revoked? YES NO If }�es,list ihe dates and reasons for rel•ocation: 2:18�97 Are �ou going to operate this business personally? �XES First �'ame \liddlc (�Saidrn) HomeAddrtts: Sveet�emc Cih' Are }rou going to ha�'e a manager or assistant in this business? (/� YES piease comp:ete the folloti�ing informalion: NO If not, �rho t�711 operate it? I.ad State \ 5 ' �' C+Q 7 � '+`'� a1'S�g �`cs y 4 ti�.�`` ro Dm� otBb�,��'� `�� O �� PLane�umba � Q� Q NO If the manager is not the same as the operamr, ,\ Finl1�'�e ��liddlcIttitial (Vaidn) Last DateofBirth \ Homc.4ddzns: Sttcet�ame CiR' Please list your emplo�ment history for the previous fice (5) }'eaz period: Business/Emolo�ment Address List all other officers of the corporation: OFFICER TITLE HOME I��AME (Office Held) ADARESS State Zip Pfione\umber HOME BUSII�'ESS PH02�'E PHONE DATE OF BIIZTH If business is a partnership, please inc3ude the follow�ing information for each partner (use additianal pages if necessaz}): Fvst \ame Home Address: $Uett �emc F;r.i xamo x�,� naa.�: sc,ttt �,n,� Middlc Initisl ?vSiddie Initisl (�laidrn) City (�laidcn) Ciry I.ari Sta[e Zip Lasc Statc Zip Datc of Birih Phone �umbcr Date aCBirth Phone humber MINNF..SOTA TAX IAENI IFICATION NiIMBER - Putsuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, Section Z(270J2) (Ta� Clearance; Issuance of Licenses), licensing authorities are required (o pro��ide to the State of Minnesota Comtnissioner of Re� enue, the Minnewta business tax ident�cation number and the social secunty number of each ]icense applicant. Under the Mitmesota Govemment Data Practices Act and the Federa] Privacy Act of 1974, we are required to ad��se you of the follo«�ing rcgarding [he use of the Minnesota Ta� Identification Number: - This informaUon may be used to deny the issuance or reneH�al of }'our license in the event }'ou o�+�e Minnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this information, the licensing authoriry u'ill supply it only to the Minnesota Depariment of Revrnue However, under the Federal Exchange of InfoRnation Agreemrnt, the Department of Re��enue may suppl}' this information to the Interna] Reeenue Sen•ice. Minnesota Tav Identification Numbers (Sales & Use Tax Number) ma}' be ob[ained from the Siate of Minneso[a, Business Records Depaztment 10 Ri��er Puk Plaza (67 2-296-63 81). Social Security Number: �� O G"' 7a l� Minnesota Tax Identifrcation Number; _ If a Minnesota Tas idrnUfication Number is not requirzd for the business being operated, indticate so 6}' p�acing an"X" dn the box. ` 2 7 8'97 L r CATION OF V�'ORKERS' COMPENSATION C0�'ERAGE PURSUANI TO MINNESOTA STANTE 176.182 9�-s�� eby certif) that I, or m}' company, am in compliance u�th the n%�:ers' compensation insurance w�'erage requiremen�s of Minnesota Statute 182, subdi� 2. I also understand that pro�zsian of false info: mation in this certiiication constitutes s�cient grounds for ad��erse aclion �st all licenses held, inciuding re��ocauon and suspension of said licenses. Narne of Inswance Compan} �� r i G�� :-� y�'i "" 1�-e/ . Policy Number: Co��erage from // f i to ��.1 �G 7- I ha��e no emplo}'ees co�'ered under «orkers wmpensation insurance S- S(AZTIALS) Ai�'1' FALSIFICATION OF ANSV1'ERS GIVEN OR MATERIAL SUBMTI'fED ♦VILL RESULT II3 DErTAL OF THIS APPLICATION i hereby siate that I hace anstcered a11 of the preceding questions, and that the information contained herean is true and correct to the best of my kno��•ledge and belief. I hereby stzte further that I have receiced no money or ocher consideralion, by �'ay of loan, gift, contribution, or othuuise, other than atready disclosed in the application u3uch I haeuith submitted I also understand this preatise ma}' be inspecied b}' police, fire, health and other cit}• officials at an}� and all times u�hen the business is in operaaon. �//b' for all applications) We ni(1 accept payment b}' cash, check (made payable to Cih� of Saint Paul) or credit card (M/C or Visa). �� 7 Aate IF PAYING BY CREDIT CA 8D PLEASE COMPLPTE THE FOLLOWING7R'FORMATION: � MasierCard � Visa EXPIRATION DATE: �= G7�9 s,�y� \ame of CarAiolder sm •*Note: If ihis application is FoodlLiquos related, please contact a Citp of Saint Paui Health Inspector, Steve Olson (266-9139), lo review plans. If an}' substantia] changes to structure are anticipated, please wntact a Citp of Saint Paul Plan Esaminer at 266-9007 to appt}' for building pemuts If there aze an} changes to Ihe parking ]ot, floor space, or for ne«� operations, please contact a City of Saint Paui Zoning Inspector at 266-9008. All applications require the foUoning documents. Piease attach these documents when submitting your appiication: l. A detailed description of the design, location and square footage of the premises to be licensed (site plan). The follo�3ing data should be on the site plan (preferably on an 8 U2° x l 1" or 8 7/2" x 14" paper): - Name, address, and phone number. - The sca]e should be stated such as 1" = ZO'. ^N should be indicated to«�azd the top. - Placement of all pertinent features of the interior of the licensed faciliry such as seating azeas, kitchens, offices, repa'u area, pazking, rest rooms, etc. - If a request is for an addition or eapansion of the licensed facility, indicate both the curreqt azea and the proposed expansion. 2. A copy of }'ow lease agreement or proof of ownership of the property. SPECIFIC LICENSE A.PPLICATIONS REQUIItE ADDTTIONAL INFORNLITION. PLEASE SEE REVERSE FOR DETAILS >>>> ACCOUM NIIMBER: '!��=lm �30T�1 �/�L�C; �3�1�6 �.v :'� s�9�