97-632Council File # � ` ��Z
Ordinance #
Green Sheet # ��
RESOLUTION
'. CITY OF SAINT PAUL, MINNESOTA s�
_ . -�� , �Ii 7 / ,
P=esented By
Referred To
Committee: Date
1 RESOLVED: That appGcation (ID #642Q3) for a Gas Station, Resta�mant-C, Grocery-C, and Cigarette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4151 (Paul Schmegal, Manager)
3 at 1580 Ford Pazkway be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absen
7 B a�cey
8 Bostrom � Off'ce o£ License Insveetions and
9 ar i
10 r e ar �nviro[�mental Protection
11 R et�s L..-s �
13 Morto� —�'
is D �' ���"1�
16 Adopted by Council: Date _�� BY. �
17
18 Adoption Certified by Council Se etary
19 Form Approved by City Attorney
20 -
21 By. c�- ,
22 / / BY' O J �-u°�
23 Appreved by Mayor: Date �t (?-!��
24
25 1 Appz'oned by Mayor for Submisaion to
26 By:
, y � Council
27
By:
q'�c-�c3Z
'J `Ihh fi
OEPARAff[iTqFFICEe�OUNCIL OATE INITIATED J I J J L
LIEP/Licensin GREEN SHEE
CONTACTPERSON & PHONE INRIFVDATE INITIAVOATE
�DEPARiMENiDIRECTOR OCENCOUNCIL
Christine Rozek, 266-9108 ^���" OCITVATfORNEY �Clfl'CIERK
NUYBEHFOR
MUST BE ON CAUNGL AGENDA BY (DATEJ n RO�7fING O eUDGET OIRECTOR O FIN. 8 MGT. SERVIGES DIR.
FOT hearin : Z� Cj [ ONDER � MqVOR (OR ASS15TANn a
TOTAL # OF 51GNATURE PAGES (CIIP ALL IACATIONS POR SIGNATURE)
ACTION REQUESTE�:
The SuperAmerica Group Division of Ashland DBA SuperAmerica �/4151 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigaxette License located
at 1580 Eord Parkway (ID 4164203).
RECOMMEN�ATIONS: Approve (A) of Fieject (F) pERSONAL SERVICE CONTHACTS MUST ANSWEfi THE FOILOWING �UESTIONS:
_ PLqNNING CqMMISSIQN _ CIVIL SEFVICE COMMISSION �� Has [his persorVt�mm ever worketl untler a coMrect tor this department?
_ CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a ciry employee?
_ STAFF — YES NO
_ DISTAIC7 COUR7 _ 3. Does this person/firm possess a skill not normally possessed by any Current ciry employee?
SUPPORTSWHICHGOUNCILOBJECTIVEI YES NO
Explatn al{ yea answers on Separete aheet am! attacfi to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What. When, Wnere. Why)�
ADVANTAGESIFAPPROVEO:
�ISADVANTAGES IFAPPROVE�.
S89�s:'e...._ . . __ _, t._ .,,_..»..
� n ...
��;� �.6 t � ��;.+7
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSAC710N $ COST/REVENUE BUDGE7ED (CIRCIE ONE) VES NO
FUNDIfdG SOURCE ACTIVITV NUMBER
FINANCIAI INFORMATION: (EXPLAIN)
Greensneet # 37932 L.I.E.P. REVIEW CHECKLIST Date: 3/z7/97 /���3Z
In Tracker? ApP'n aeceived / npp'n Processed
LiCenselD# 64203 LicenseType:�as Station Restaurant–G. Gr�cerv–C_ ana �;ga,-flrro T;cen
COmpany NdfTle: SunerAmerica Group D'v� ion of Aahland DBA: SupexAmerica ��4151
Business Addresss: 1580 Ford Parkwav Business Phone: 690-3036
Contact MamefAddresS: Paul Schmegal, 1580 Ford Parkwav Home Phone:
55116
Date to Counc�l Research:
Public Heari�g Date: � � ��
Notice Sent to Applicant:
.�//�7 �����
Notice Sent to Public�
Labels Ordered: i ✓f�
District Council #: %
Ward #: � �
Department/ Date Inspections Comments
City Attomey
�•2• 0.�. •
Environmental
Health
�.
Fire
. �.� .
License �� P�� ������—
Lease Received:
�[ �� �1 a ��
Police
s-ZGI�-- �.�.
Zoning
�•� �
MRR-19-1997 11�08 CITY OF ST PR�L LIEP 612 266 9124 P,
' _ °'�° . • / �! n _
CT.ASS III C1TY OF SAIlVT pAt�� `o3Z...
LiCENSE APPLICATION °�"��"`��°�
A � /� r : a,�aF-:=�;��
��c� �ot � �aao, Wr��, �� d�,3z, ��p����
� �� ���2<
�.°�� , � ��vi�� { ��r`�"�� , �
`�'$ Y C
PI-EASE T'YPE OR YRINT }N INK .
T�pe ofLiceose(s) bein�
Compffiy Name:
�
Corpontioa �PaMet�{yp / sate emprieiacs5ip
Ifbvsiness is incoiporated, gve date of incotporation: _
�sa��a�:..�ie.,.� eA .1 '
$»smess Adaress: 1 � �0 �Ult�
smsaaa�eu
gC1WMR W'IIHI C70SS SZSGCL4 1S �C tIiL4IICSS;OC81P13�
Are the premises uow { o�ccu / p�ied7 ,w, What T e o
Maii T'o.4�dress: _ l' N� V Yi /�/L��1 T
��
APPIicffiuIafozmation� ����
Name sad Titic:
sffn :�am�
x� Aaa��: �G Q(/l� � t,/tl
�-�az -
Ciry
c�wa�,�
Stne y�
Which side of the satiet�
� �as�Z
�
n... �,,
A�S f ai�4�l.li�� e�t�.
� r,s�
su�a.9amW, �� �
L7ate of Birth: � � .. � �'
�O V'� Place of $irth Home Phone�rA f. :�'7— t� w
Iiave yoa ever been comicted of aap fclony, aime or violaGOn ofany ciry ordinance othez than tra�ic? YES
Dateofarr�st: -- NO�_
Where7
Chargc
Com�iction: Sentaia:
I,ist th� nsmes �dresidences of three persons of good moral charactcr, fiving within the Twin Cities Mehro Area, not rdatcd to the apglicant
�' �dslly interested ia lhepzemi.s,-s or business, who may b� refcaed to ss to the applicaut's characta:
B A (► � �DRESS PHONE
., 0��,,,1 S" 1 `l 7 0 SI�N D S*S . �j �jF G 1�. �1.3L Sr: �
- it��w $rt: �L-I.N c � � .
�lO�a,foLll1GT1}'
Kave
Y
JAtCiC�lS4:
revoked? YES � NO ffyes, 2ist the dates sad masons ioz revocetioa:
2/18�9'7
- `� 512 266 9124 P.04i06
/ °�"��3Z
_ rE5 r� No ffno; �rho wiA operau ��PERAMERICA Gip0�1
..s�e
,. � to �ti a�mzga' oressf�zat in this busiaess? YES :�O tf the msnzger is not the s2me �s Pne operator,
: complet�ihe follouing iru`ormeteon:
�
Ci.y
Pl«u list yo� emplo;meni histosy for tbe prc�7ou 5ve (5} ceu paiod:
B'�1GRRrnmcnt Address
Stsic t'n Phwe �+mfiec
is a
info;matioafor each parmer (use addirionsl pagcs if aaessary):
(
HaxAdMeu 5wa\m�e CGry SWc 7�a A+�'.�`�bQ
F'ra� 9S'iddSoInitid (>Sai&a) Lau DmeefBash
£i�sRdd=as: Sext?:xme C�iy Statc Zip P6aoc\`wnbtt
MINI�'F.SO7A TAX IDENTIFICATION NUMBER - Piusaant to the Laws of Minuesota,1984, Chagur 502, Artic3e 8, Sec2ion 2(270.72J
�7a� G7e�u; issusace ofLicensesj.liarssing azuhozides are req�ed to procnde to tbe State of Mwxteso� Commissioner of 3tevmue, the
Mwnaota buriucss tax identiScation number aad the social sawiry rn�ber of c$ch licrosc sppfic�t
Uudei �hc Mmn�ota Gwermnait DataPradices Aa �sd the Fedcal Pricacy Aa of i97Q, we me required to advise you oftho follouing
rtigardiug the use aftke 2vl�esota Tsc Idearification I3uroba:
- I3is inf�arion msq be used to de� tfie ;�„� or reaewal of yo�u iicrnse in tfie evcm you owe Mwnesots sates, empIayds
witb5oldmg or motor vd�icle excise ta�cc�
' uP°Il �8 tLis ivfoxmsfion. tfie Iiceasiag aut}tority w�l supply it oaly W the Mutneswa Lkpaztroeat of Revenva However,
undu the Fedual Exc3angt af information A�m; tbe Department of Reveaue maY �PPt9 this infoxmatraa'to t5k SMaaai
Revenue Seii�ict � �
�a T�IdcatiSr�oa2�mbas CSales &Use TmcN�vba3 maY6e obisined fcoxa tLe S�au of 1vEnnesots, Busincss Recor3s Department.
10itivaParkPlaza(612-296-618i} - ....
soc;al sxurity r7vmb� l" 1} J�-�-�S !l _ M�nnes�, Tsx Ia�bScation I.*�'4a- - l� 7�[3 v�S
_ Ff a 2.�aoesotn Tax IdrntiScau�i Numba is not requued for me businas being apcatec� iadicate so tsy piaciag aa'X` in $x t�
,,, a �,�
List zlt oLha oa�as of the corpo: ction:
pFEiCER TITL.E HO?vfE HO.V�E BUSLQESS DATE OF
?aa±.�F (O��ceHeLl] . ADL�RES5 PHO\'E PFiOA� BIRTFI
Council File # � ` ��Z
Ordinance #
Green Sheet # ��
RESOLUTION
'. CITY OF SAINT PAUL, MINNESOTA s�
_ . -�� , �Ii 7 / ,
P=esented By
Referred To
Committee: Date
1 RESOLVED: That appGcation (ID #642Q3) for a Gas Station, Resta�mant-C, Grocery-C, and Cigarette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4151 (Paul Schmegal, Manager)
3 at 1580 Ford Pazkway be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absen
7 B a�cey
8 Bostrom � Off'ce o£ License Insveetions and
9 ar i
10 r e ar �nviro[�mental Protection
11 R et�s L..-s �
13 Morto� —�'
is D �' ���"1�
16 Adopted by Council: Date _�� BY. �
17
18 Adoption Certified by Council Se etary
19 Form Approved by City Attorney
20 -
21 By. c�- ,
22 / / BY' O J �-u°�
23 Appreved by Mayor: Date �t (?-!��
24
25 1 Appz'oned by Mayor for Submisaion to
26 By:
, y � Council
27
By:
q'�c-�c3Z
'J `Ihh fi
OEPARAff[iTqFFICEe�OUNCIL OATE INITIATED J I J J L
LIEP/Licensin GREEN SHEE
CONTACTPERSON & PHONE INRIFVDATE INITIAVOATE
�DEPARiMENiDIRECTOR OCENCOUNCIL
Christine Rozek, 266-9108 ^���" OCITVATfORNEY �Clfl'CIERK
NUYBEHFOR
MUST BE ON CAUNGL AGENDA BY (DATEJ n RO�7fING O eUDGET OIRECTOR O FIN. 8 MGT. SERVIGES DIR.
FOT hearin : Z� Cj [ ONDER � MqVOR (OR ASS15TANn a
TOTAL # OF 51GNATURE PAGES (CIIP ALL IACATIONS POR SIGNATURE)
ACTION REQUESTE�:
The SuperAmerica Group Division of Ashland DBA SuperAmerica �/4151 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigaxette License located
at 1580 Eord Parkway (ID 4164203).
RECOMMEN�ATIONS: Approve (A) of Fieject (F) pERSONAL SERVICE CONTHACTS MUST ANSWEfi THE FOILOWING �UESTIONS:
_ PLqNNING CqMMISSIQN _ CIVIL SEFVICE COMMISSION �� Has [his persorVt�mm ever worketl untler a coMrect tor this department?
_ CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a ciry employee?
_ STAFF — YES NO
_ DISTAIC7 COUR7 _ 3. Does this person/firm possess a skill not normally possessed by any Current ciry employee?
SUPPORTSWHICHGOUNCILOBJECTIVEI YES NO
Explatn al{ yea answers on Separete aheet am! attacfi to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What. When, Wnere. Why)�
ADVANTAGESIFAPPROVEO:
�ISADVANTAGES IFAPPROVE�.
S89�s:'e...._ . . __ _, t._ .,,_..»..
� n ...
��;� �.6 t � ��;.+7
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSAC710N $ COST/REVENUE BUDGE7ED (CIRCIE ONE) VES NO
FUNDIfdG SOURCE ACTIVITV NUMBER
FINANCIAI INFORMATION: (EXPLAIN)
Greensneet # 37932 L.I.E.P. REVIEW CHECKLIST Date: 3/z7/97 /���3Z
In Tracker? ApP'n aeceived / npp'n Processed
LiCenselD# 64203 LicenseType:�as Station Restaurant–G. Gr�cerv–C_ ana �;ga,-flrro T;cen
COmpany NdfTle: SunerAmerica Group D'v� ion of Aahland DBA: SupexAmerica ��4151
Business Addresss: 1580 Ford Parkwav Business Phone: 690-3036
Contact MamefAddresS: Paul Schmegal, 1580 Ford Parkwav Home Phone:
55116
Date to Counc�l Research:
Public Heari�g Date: � � ��
Notice Sent to Applicant:
.�//�7 �����
Notice Sent to Public�
Labels Ordered: i ✓f�
District Council #: %
Ward #: � �
Department/ Date Inspections Comments
City Attomey
�•2• 0.�. •
Environmental
Health
�.
Fire
. �.� .
License �� P�� ������—
Lease Received:
�[ �� �1 a ��
Police
s-ZGI�-- �.�.
Zoning
�•� �
MRR-19-1997 11�08 CITY OF ST PR�L LIEP 612 266 9124 P,
' _ °'�° . • / �! n _
CT.ASS III C1TY OF SAIlVT pAt�� `o3Z...
LiCENSE APPLICATION °�"��"`��°�
A � /� r : a,�aF-:=�;��
��c� �ot � �aao, Wr��, �� d�,3z, ��p����
� �� ���2<
�.°�� , � ��vi�� { ��r`�"�� , �
`�'$ Y C
PI-EASE T'YPE OR YRINT }N INK .
T�pe ofLiceose(s) bein�
Compffiy Name:
�
Corpontioa �PaMet�{yp / sate emprieiacs5ip
Ifbvsiness is incoiporated, gve date of incotporation: _
�sa��a�:..�ie.,.� eA .1 '
$»smess Adaress: 1 � �0 �Ult�
smsaaa�eu
gC1WMR W'IIHI C70SS SZSGCL4 1S �C tIiL4IICSS;OC81P13�
Are the premises uow { o�ccu / p�ied7 ,w, What T e o
Maii T'o.4�dress: _ l' N� V Yi /�/L��1 T
��
APPIicffiuIafozmation� ����
Name sad Titic:
sffn :�am�
x� Aaa��: �G Q(/l� � t,/tl
�-�az -
Ciry
c�wa�,�
Stne y�
Which side of the satiet�
� �as�Z
�
n... �,,
A�S f ai�4�l.li�� e�t�.
� r,s�
su�a.9amW, �� �
L7ate of Birth: � � .. � �'
�O V'� Place of $irth Home Phone�rA f. :�'7— t� w
Iiave yoa ever been comicted of aap fclony, aime or violaGOn ofany ciry ordinance othez than tra�ic? YES
Dateofarr�st: -- NO�_
Where7
Chargc
Com�iction: Sentaia:
I,ist th� nsmes �dresidences of three persons of good moral charactcr, fiving within the Twin Cities Mehro Area, not rdatcd to the apglicant
�' �dslly interested ia lhepzemi.s,-s or business, who may b� refcaed to ss to the applicaut's characta:
B A (► � �DRESS PHONE
., 0��,,,1 S" 1 `l 7 0 SI�N D S*S . �j �jF G 1�. �1.3L Sr: �
- it��w $rt: �L-I.N c � � .
�lO�a,foLll1GT1}'
Kave
Y
JAtCiC�lS4:
revoked? YES � NO ffyes, 2ist the dates sad masons ioz revocetioa:
2/18�9'7
- `� 512 266 9124 P.04i06
/ °�"��3Z
_ rE5 r� No ffno; �rho wiA operau ��PERAMERICA Gip0�1
..s�e
,. � to �ti a�mzga' oressf�zat in this busiaess? YES :�O tf the msnzger is not the s2me �s Pne operator,
: complet�ihe follouing iru`ormeteon:
�
Ci.y
Pl«u list yo� emplo;meni histosy for tbe prc�7ou 5ve (5} ceu paiod:
B'�1GRRrnmcnt Address
Stsic t'n Phwe �+mfiec
is a
info;matioafor each parmer (use addirionsl pagcs if aaessary):
(
HaxAdMeu 5wa\m�e CGry SWc 7�a A+�'.�`�bQ
F'ra� 9S'iddSoInitid (>Sai&a) Lau DmeefBash
£i�sRdd=as: Sext?:xme C�iy Statc Zip P6aoc\`wnbtt
MINI�'F.SO7A TAX IDENTIFICATION NUMBER - Piusaant to the Laws of Minuesota,1984, Chagur 502, Artic3e 8, Sec2ion 2(270.72J
�7a� G7e�u; issusace ofLicensesj.liarssing azuhozides are req�ed to procnde to tbe State of Mwxteso� Commissioner of 3tevmue, the
Mwnaota buriucss tax identiScation number aad the social sawiry rn�ber of c$ch licrosc sppfic�t
Uudei �hc Mmn�ota Gwermnait DataPradices Aa �sd the Fedcal Pricacy Aa of i97Q, we me required to advise you oftho follouing
rtigardiug the use aftke 2vl�esota Tsc Idearification I3uroba:
- I3is inf�arion msq be used to de� tfie ;�„� or reaewal of yo�u iicrnse in tfie evcm you owe Mwnesots sates, empIayds
witb5oldmg or motor vd�icle excise ta�cc�
' uP°Il �8 tLis ivfoxmsfion. tfie Iiceasiag aut}tority w�l supply it oaly W the Mutneswa Lkpaztroeat of Revenva However,
undu the Fedual Exc3angt af information A�m; tbe Department of Reveaue maY �PPt9 this infoxmatraa'to t5k SMaaai
Revenue Seii�ict � �
�a T�IdcatiSr�oa2�mbas CSales &Use TmcN�vba3 maY6e obisined fcoxa tLe S�au of 1vEnnesots, Busincss Recor3s Department.
10itivaParkPlaza(612-296-618i} - ....
soc;al sxurity r7vmb� l" 1} J�-�-�S !l _ M�nnes�, Tsx Ia�bScation I.*�'4a- - l� 7�[3 v�S
_ Ff a 2.�aoesotn Tax IdrntiScau�i Numba is not requued for me businas being apcatec� iadicate so tsy piaciag aa'X` in $x t�
,,, a �,�
List zlt oLha oa�as of the corpo: ction:
pFEiCER TITL.E HO?vfE HO.V�E BUSLQESS DATE OF
?aa±.�F (O��ceHeLl] . ADL�RES5 PHO\'E PFiOA� BIRTFI
Council File # � ` ��Z
Ordinance #
Green Sheet # ��
RESOLUTION
'. CITY OF SAINT PAUL, MINNESOTA s�
_ . -�� , �Ii 7 / ,
P=esented By
Referred To
Committee: Date
1 RESOLVED: That appGcation (ID #642Q3) for a Gas Station, Resta�mant-C, Grocery-C, and Cigarette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4151 (Paul Schmegal, Manager)
3 at 1580 Ford Pazkway be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays Absen
7 B a�cey
8 Bostrom � Off'ce o£ License Insveetions and
9 ar i
10 r e ar �nviro[�mental Protection
11 R et�s L..-s �
13 Morto� —�'
is D �' ���"1�
16 Adopted by Council: Date _�� BY. �
17
18 Adoption Certified by Council Se etary
19 Form Approved by City Attorney
20 -
21 By. c�- ,
22 / / BY' O J �-u°�
23 Appreved by Mayor: Date �t (?-!��
24
25 1 Appz'oned by Mayor for Submisaion to
26 By:
, y � Council
27
By:
q'�c-�c3Z
'J `Ihh fi
OEPARAff[iTqFFICEe�OUNCIL OATE INITIATED J I J J L
LIEP/Licensin GREEN SHEE
CONTACTPERSON & PHONE INRIFVDATE INITIAVOATE
�DEPARiMENiDIRECTOR OCENCOUNCIL
Christine Rozek, 266-9108 ^���" OCITVATfORNEY �Clfl'CIERK
NUYBEHFOR
MUST BE ON CAUNGL AGENDA BY (DATEJ n RO�7fING O eUDGET OIRECTOR O FIN. 8 MGT. SERVIGES DIR.
FOT hearin : Z� Cj [ ONDER � MqVOR (OR ASS15TANn a
TOTAL # OF 51GNATURE PAGES (CIIP ALL IACATIONS POR SIGNATURE)
ACTION REQUESTE�:
The SuperAmerica Group Division of Ashland DBA SuperAmerica �/4151 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigaxette License located
at 1580 Eord Parkway (ID 4164203).
RECOMMEN�ATIONS: Approve (A) of Fieject (F) pERSONAL SERVICE CONTHACTS MUST ANSWEfi THE FOILOWING �UESTIONS:
_ PLqNNING CqMMISSIQN _ CIVIL SEFVICE COMMISSION �� Has [his persorVt�mm ever worketl untler a coMrect tor this department?
_ CIB COMMITTEE _ YES NO
2. Has this person/firm ever been a ciry employee?
_ STAFF — YES NO
_ DISTAIC7 COUR7 _ 3. Does this person/firm possess a skill not normally possessed by any Current ciry employee?
SUPPORTSWHICHGOUNCILOBJECTIVEI YES NO
Explatn al{ yea answers on Separete aheet am! attacfi to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What. When, Wnere. Why)�
ADVANTAGESIFAPPROVEO:
�ISADVANTAGES IFAPPROVE�.
S89�s:'e...._ . . __ _, t._ .,,_..»..
� n ...
��;� �.6 t � ��;.+7
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSAC710N $ COST/REVENUE BUDGE7ED (CIRCIE ONE) VES NO
FUNDIfdG SOURCE ACTIVITV NUMBER
FINANCIAI INFORMATION: (EXPLAIN)
Greensneet # 37932 L.I.E.P. REVIEW CHECKLIST Date: 3/z7/97 /���3Z
In Tracker? ApP'n aeceived / npp'n Processed
LiCenselD# 64203 LicenseType:�as Station Restaurant–G. Gr�cerv–C_ ana �;ga,-flrro T;cen
COmpany NdfTle: SunerAmerica Group D'v� ion of Aahland DBA: SupexAmerica ��4151
Business Addresss: 1580 Ford Parkwav Business Phone: 690-3036
Contact MamefAddresS: Paul Schmegal, 1580 Ford Parkwav Home Phone:
55116
Date to Counc�l Research:
Public Heari�g Date: � � ��
Notice Sent to Applicant:
.�//�7 �����
Notice Sent to Public�
Labels Ordered: i ✓f�
District Council #: %
Ward #: � �
Department/ Date Inspections Comments
City Attomey
�•2• 0.�. •
Environmental
Health
�.
Fire
. �.� .
License �� P�� ������—
Lease Received:
�[ �� �1 a ��
Police
s-ZGI�-- �.�.
Zoning
�•� �
MRR-19-1997 11�08 CITY OF ST PR�L LIEP 612 266 9124 P,
' _ °'�° . • / �! n _
CT.ASS III C1TY OF SAIlVT pAt�� `o3Z...
LiCENSE APPLICATION °�"��"`��°�
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PI-EASE T'YPE OR YRINT }N INK .
T�pe ofLiceose(s) bein�
Compffiy Name:
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Corpontioa �PaMet�{yp / sate emprieiacs5ip
Ifbvsiness is incoiporated, gve date of incotporation: _
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$»smess Adaress: 1 � �0 �Ult�
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Are the premises uow { o�ccu / p�ied7 ,w, What T e o
Maii T'o.4�dress: _ l' N� V Yi /�/L��1 T
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APPIicffiuIafozmation� ����
Name sad Titic:
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Which side of the satiet�
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L7ate of Birth: � � .. � �'
�O V'� Place of $irth Home Phone�rA f. :�'7— t� w
Iiave yoa ever been comicted of aap fclony, aime or violaGOn ofany ciry ordinance othez than tra�ic? YES
Dateofarr�st: -- NO�_
Where7
Chargc
Com�iction: Sentaia:
I,ist th� nsmes �dresidences of three persons of good moral charactcr, fiving within the Twin Cities Mehro Area, not rdatcd to the apglicant
�' �dslly interested ia lhepzemi.s,-s or business, who may b� refcaed to ss to the applicaut's characta:
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Kave
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JAtCiC�lS4:
revoked? YES � NO ffyes, 2ist the dates sad masons ioz revocetioa:
2/18�9'7
- `� 512 266 9124 P.04i06
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_ rE5 r� No ffno; �rho wiA operau ��PERAMERICA Gip0�1
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,. � to �ti a�mzga' oressf�zat in this busiaess? YES :�O tf the msnzger is not the s2me �s Pne operator,
: complet�ihe follouing iru`ormeteon:
�
Ci.y
Pl«u list yo� emplo;meni histosy for tbe prc�7ou 5ve (5} ceu paiod:
B'�1GRRrnmcnt Address
Stsic t'n Phwe �+mfiec
is a
info;matioafor each parmer (use addirionsl pagcs if aaessary):
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HaxAdMeu 5wa\m�e CGry SWc 7�a A+�'.�`�bQ
F'ra� 9S'iddSoInitid (>Sai&a) Lau DmeefBash
£i�sRdd=as: Sext?:xme C�iy Statc Zip P6aoc\`wnbtt
MINI�'F.SO7A TAX IDENTIFICATION NUMBER - Piusaant to the Laws of Minuesota,1984, Chagur 502, Artic3e 8, Sec2ion 2(270.72J
�7a� G7e�u; issusace ofLicensesj.liarssing azuhozides are req�ed to procnde to tbe State of Mwxteso� Commissioner of 3tevmue, the
Mwnaota buriucss tax identiScation number aad the social sawiry rn�ber of c$ch licrosc sppfic�t
Uudei �hc Mmn�ota Gwermnait DataPradices Aa �sd the Fedcal Pricacy Aa of i97Q, we me required to advise you oftho follouing
rtigardiug the use aftke 2vl�esota Tsc Idearification I3uroba:
- I3is inf�arion msq be used to de� tfie ;�„� or reaewal of yo�u iicrnse in tfie evcm you owe Mwnesots sates, empIayds
witb5oldmg or motor vd�icle excise ta�cc�
' uP°Il �8 tLis ivfoxmsfion. tfie Iiceasiag aut}tority w�l supply it oaly W the Mutneswa Lkpaztroeat of Revenva However,
undu the Fedual Exc3angt af information A�m; tbe Department of Reveaue maY �PPt9 this infoxmatraa'to t5k SMaaai
Revenue Seii�ict � �
�a T�IdcatiSr�oa2�mbas CSales &Use TmcN�vba3 maY6e obisined fcoxa tLe S�au of 1vEnnesots, Busincss Recor3s Department.
10itivaParkPlaza(612-296-618i} - ....
soc;al sxurity r7vmb� l" 1} J�-�-�S !l _ M�nnes�, Tsx Ia�bScation I.*�'4a- - l� 7�[3 v�S
_ Ff a 2.�aoesotn Tax IdrntiScau�i Numba is not requued for me businas being apcatec� iadicate so tsy piaciag aa'X` in $x t�
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List zlt oLha oa�as of the corpo: ction:
pFEiCER TITL.E HO?vfE HO.V�E BUSLQESS DATE OF
?aa±.�F (O��ceHeLl] . ADL�RES5 PHO\'E PFiOA� BIRTFI