97-633Council File ¢ - ` �b
ordinance #
Green Sheet # �✓ ✓
RESOLUTION
�� � � '- �..,,. O� INT PAUL, MINNESOTA �)
[.� v �
Presented By
Re£erred To
Committee: Date
1 RESOLVED: That application (ID #98886) for a Gas Station, Restaurant-D, Crrocery-C, and Cigazette License by
z Super America Group Division of Asliland DBA SupetAmerica #4419 (Clayton Bleske, Manager)
3 at 925 Grand Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs se
7 B a�kekev —
9 Har� � Off�ce of L,icense Insg�ctions and
10 M r � Environmental Protection -
11
12 T une
14 Morton —�' / I,� ��
15 � By. I� �-y i
16 Adopted by Council: Date �$ qq �
17
1S Adoption Certified by Council Secretary
19 Form Approved by City Atto�
20
21 By:
22 BY '
23 Approved by Mayor: Date 4� �/��--
24
zs r Approved by Mayor for Submission to
26 $y. (�,_ Council
27
By: _
�"�b3�
D PApTMEMT/OFFICFJCOUNCIL DATEINRIATED GREEN SHEE N� 35323
LIEPfLicensin — -"
CpNTACT PEp50N & PHONE � p � A �� p��QqN1ilAVDATE O CITY COUNCIL INITIALIDATE
Christine RoZek 266-9108 "�'�" � crtvnrroaNer � cmc�aK
MUST BE ON fAUNCIL AGENDA BY (OATE) pp�MpG� � BUOGET �IRECTOR � FIN. & MGT. SERVICES DIR.
Z /� ORDER � Mpypp (OR ASSISTANn �
For hearin : �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATONS FOR SIGNATURE)
ACTION iiC-0UE5TED:
The SuperAmerica Group Division ot Ashland DBA SuperAmerica 9t4419 requests Council approval
of its application for a Gas Staiton, Res[aurant-D, Grocery-C, and Cigarette I.icense at
925 Grand Avenue (ID 9t98886).
aECOMMENDAT�ONS: Apqove (A) or Reiea (R) PERSONAL SERVICE CONTRACTS MUST ANSWER 7HE FOILOWING QVESTIONS:
_ PLANNING CAMMISSION _ CIVIL SEflV10E COMMISSION �� Has ihis persoNfirm ever wo�ketl untler a conVaci for this tlepadment? -
_ c�e caaMmEe _ vES - NO
2. Has this personfirm ever 6een a city employee?
_ STAFF — YES NO
_ Dis7piCT CAUq7 _ 3. Does this pereoNfirm possess a skill not nortnall �
y po5sessed by any current city employee.
SUPPOfiTSWHICHCOUNCILOBJECTIVEI YES NO
Expiafn all yes answers on separate sheet and attach to 9�� eneet
INRIATING PROBLEM, ISSUE, OPPORTUNI7Y(Who. WM1at, When, Where, Why)
ADVANTAGES IF APPROVED:
DISADVANTAQES IFAPPROVED:
�s3�"��{� �.,�°��Z�v�` R�eR�§�
��i,�s�' �, � t��$
DISADVANTAdES IF NO�APPROVED:
TOTAL AMOUNi OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOUNCE ACTIVITY NUMBEq
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35323 L.I.E.P. REVIEW CHECKLIST Date: 3127197 � S�
In Tf3Ckel? App'n qeceived / App'n Processed
LiCenselD # 98886 License Type: Gas Station, Restaurant-D, Grocerv-C, and Ciearette
Company Name:SuperAmerica Grou➢ Division of Ashland DBA: SunerAmerica 414419_ __
BUSiness Addresss: 925 Grand Avenue Susiness Phone: " 222-7216
Contact Name/Address: Clavton Bleske, 925 Grand Ave 105 Home Phone:
Date to Council Research:
Public Hearing Date:� � 2 �
Notice Sent to AppiicaM: -� �
�, �, .-r..f
Labels Ordered: y�
District Couocil #: ��
p C 5'-i �< . _.-.i
Notice Sent to Pubtic: �� � ���y� Ward #: o�
DepaRmentJ Date lnspections Commerts
City Attorney
5
Environmental
Health
� .�
Fire
Jr ! "�L��` 0 • 7 � •
License Siee Plan Received:_
I.ease Received:
���� �� �!�
Police
�O`L� c7•� '
Zoning
���{ `�'�- �. �• .
MAR-19-1997 11:08 CITY OF ST PRUL LIEP
_.�
.
CT.ASS III crrX oF sanvr pnu[,
o�«�t.;�,r�a;eK
LICENSB APPL�CATION �a���
i � : ������
��.� ��
��5��v"c�'t�z' ��t �oao `�o��, `�t�''° �'3�� `������,�6
�s �ttc �i�� , � ' S 4�ii��� `�'� !, �f�at.�� c�.$
PLEASE'i'YPE ORPRINI' IlV II�IIC ��
I'cpe of License(s) being app&ed for:
CampffiyName: ..Z�.t.�'! � FF WlL R.l (.Y�
C4rpoMiiou /PaLHS�hip / Sote Aaprictnnhip
If business is incorporated, gve date of incoiporation: _
lloia8 $usiness As: � R. � �l �
g�A�: qa5 t2A-�l.�,ve
G -•
seeec aaa�m �+�r
Between what cross �ts is the busiuess located? _
Are tix pren�ises now occupied7 �'hat Type ofBusiness?
r� ro a.aa��: .� O B U1G t!,(UU S'C Le �c i N��t
s�a aae�. c;r
x�,e sna r�u�:
��
ar,aau
Home Address:
caraza��
- sa<aaaane Gry s�uc Zsp
Date of Binh; 1( ��s - l� '� Place of $lrth: Aome Phone:�a4 f. 3 S7 ���,�
Have you ever been com�cted of anq feIocry, crzuu os viol�ion of any city ordizsance other than �c? YES _ IQO �_
D�te of azrest: Whete7
Charge:
Convictioa: Seataia:
I.ist dx nsmes �d �dences of three peisons of good moral charsetcr, living within the Twin Cities Meiro Area, not rdated to the applicant
or finrvcially interested in ffie premi�s or business, who may be r�f�ed to as to t�e app3icanYs characfer:
NAME ADDRESS PHONE
��tt�� ll�e�,�it,� S— 1�(7� 0—yaND S7:S .�t-�}��- G,11-`�13L-s3�7
Lold, formcly hc1d, or
Have an} of the abovc n�ed
f� J7 �v N
�I�ta Gl -
Ftave an lAfei'C,t Ip:
612 266 9124 P.
s TU?��/
.S ii
S t Ui
s I ;��'�;
�33
�► V �'� AS� 1kNd -�-NC-
-36
Busiaess Fhon� 12 �a' � 2l �o
,IT �/ srio�'
s� z�,
Which side of the strect�
u l�ti y0S/'2._
� � �
�V.4�vr f 9�r�i�t � �
� r�x
°.1_.1.�v t►J.
been revokedP YES � NO If y�s, list the dates �d reasons tor revocatioa:
2/18N9
i9`7 11�08 C1TY OF ST PRUL LIEP 612 266 9124 P.04i06
/ a e-�3
operrse this busiaess pesonally? � cS _,�L..� 130 If nob �rho u-iU operEte ��IPERAMERICAG1�lilll�
7� Dntc o
.t f�a��� ' ��Zr�ii"���p
Slck 2ip Pkro:+o:�3cnbes
Pkzu list your ernplrnmen! history fer we prc�la.0 5ve (5) cezr period:
Bus�nesslEtqpirn Address
iafo;mation for eaeh parmer (use additional pages if aecesssffiy):
Fita�sme
Home Addreu 5vaes \mse City Swc Zip Phone?�mba
Fcu\ame .W'iddleiaitd (.�Lidrn1 T.ast DefeefBatb
HoneAd6ia�t� Sma2'.cue Gry Stau Zip 3Yneee?.`umbet
MINIr'E507A TAX IDSNTffICATION NEJMBER - P�usuaat to 4x La�rs of DSnaesota,1984, Chapta 502, Article 8, SEM�on 2{270.72)
(Ta� Cle�nce; Issusnoe of Licenses). T�cnsing suthmities are rec��ed to pmende to tbe State of 2+/u�aesota Commissi�er of Reveaiu. tt�e
M'wnaota bw�aess tsx id�aafication numbet aod the social securiry a�ber of each licease applicant.
Uuder the Mmaeso+a Go�amncat Dats Pr�tias Aa aud �e Fedarl Aicacp Ad of f 97d, we sre rcquir� to advise you of the foIlaw�iug
regazcimg the use �'t6e M�esota TaxI�cation isvmba:
-?his i�mati� may be uscd W ckuq the:n a reaewat of ymu Eicc¢sc in the cvcat you owe l�umesota sates, employe� s
witbholdmg a mM� ve3ricle exase taxe�
' UP°n r�v�8 tlus infacrostioa, tlie Iicwsiag au4priry w�l supply it onty W t� Mumesota Dcpatuaeat of Rtvenue. However,
unda tbe Federal FxcLauge af Information A�t, tbe Departman of Revenue maY �PPtY this inf'ormatian m tfie Intttasl
Reveaue Seiiri,x.
M� Tau IdmUSeatiaatNumbas (Sales & Us�?Ex Numba') may be ob�med &� tBe S�ate ofM�� B�� �� �Pmimau.
lORivaParkPlaza fb12-296-6181} _ .. . -
�� s�� r��:.� /— O ! �a-�S G-_ �� r�x �,�c�� rr,mm�: !� �3 �SS
_ Jf a D+&aaesota Fsx Identi5carioa Nvmba is aot requ�cd for the businas bemg opaated, indicau so by placing aa'X' ia ihe box
�„e��
pse c� �g tnfizre a�g� oresss.�c ia this husiness? ✓�S NO 7f the ma:�zger is not the seme �s tLe operator,
p}exse wmplete che follouiag
yist zll uther o�cas of the co:po�tion:
pF�iCER TI'I�.E HO?vt6 H0� Bi7SL�*ESS DATEOF
?.*4?�,iF (OffixHekl] . ADIl�ESS PHO�'E PHOATE BIILTH
Council File ¢ - ` �b
ordinance #
Green Sheet # �✓ ✓
RESOLUTION
�� � � '- �..,,. O� INT PAUL, MINNESOTA �)
[.� v �
Presented By
Re£erred To
Committee: Date
1 RESOLVED: That application (ID #98886) for a Gas Station, Restaurant-D, Crrocery-C, and Cigazette License by
z Super America Group Division of Asliland DBA SupetAmerica #4419 (Clayton Bleske, Manager)
3 at 925 Grand Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs se
7 B a�kekev —
9 Har� � Off�ce of L,icense Insg�ctions and
10 M r � Environmental Protection -
11
12 T une
14 Morton —�' / I,� ��
15 � By. I� �-y i
16 Adopted by Council: Date �$ qq �
17
1S Adoption Certified by Council Secretary
19 Form Approved by City Atto�
20
21 By:
22 BY '
23 Approved by Mayor: Date 4� �/��--
24
zs r Approved by Mayor for Submission to
26 $y. (�,_ Council
27
By: _
�"�b3�
D PApTMEMT/OFFICFJCOUNCIL DATEINRIATED GREEN SHEE N� 35323
LIEPfLicensin — -"
CpNTACT PEp50N & PHONE � p � A �� p��QqN1ilAVDATE O CITY COUNCIL INITIALIDATE
Christine RoZek 266-9108 "�'�" � crtvnrroaNer � cmc�aK
MUST BE ON fAUNCIL AGENDA BY (OATE) pp�MpG� � BUOGET �IRECTOR � FIN. & MGT. SERVICES DIR.
Z /� ORDER � Mpypp (OR ASSISTANn �
For hearin : �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATONS FOR SIGNATURE)
ACTION iiC-0UE5TED:
The SuperAmerica Group Division ot Ashland DBA SuperAmerica 9t4419 requests Council approval
of its application for a Gas Staiton, Res[aurant-D, Grocery-C, and Cigarette I.icense at
925 Grand Avenue (ID 9t98886).
aECOMMENDAT�ONS: Apqove (A) or Reiea (R) PERSONAL SERVICE CONTRACTS MUST ANSWER 7HE FOILOWING QVESTIONS:
_ PLANNING CAMMISSION _ CIVIL SEflV10E COMMISSION �� Has ihis persoNfirm ever wo�ketl untler a conVaci for this tlepadment? -
_ c�e caaMmEe _ vES - NO
2. Has this personfirm ever 6een a city employee?
_ STAFF — YES NO
_ Dis7piCT CAUq7 _ 3. Does this pereoNfirm possess a skill not nortnall �
y po5sessed by any current city employee.
SUPPOfiTSWHICHCOUNCILOBJECTIVEI YES NO
Expiafn all yes answers on separate sheet and attach to 9�� eneet
INRIATING PROBLEM, ISSUE, OPPORTUNI7Y(Who. WM1at, When, Where, Why)
ADVANTAGES IF APPROVED:
DISADVANTAQES IFAPPROVED:
�s3�"��{� �.,�°��Z�v�` R�eR�§�
��i,�s�' �, � t��$
DISADVANTAdES IF NO�APPROVED:
TOTAL AMOUNi OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOUNCE ACTIVITY NUMBEq
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35323 L.I.E.P. REVIEW CHECKLIST Date: 3127197 � S�
In Tf3Ckel? App'n qeceived / App'n Processed
LiCenselD # 98886 License Type: Gas Station, Restaurant-D, Grocerv-C, and Ciearette
Company Name:SuperAmerica Grou➢ Division of Ashland DBA: SunerAmerica 414419_ __
BUSiness Addresss: 925 Grand Avenue Susiness Phone: " 222-7216
Contact Name/Address: Clavton Bleske, 925 Grand Ave 105 Home Phone:
Date to Council Research:
Public Hearing Date:� � 2 �
Notice Sent to AppiicaM: -� �
�, �, .-r..f
Labels Ordered: y�
District Couocil #: ��
p C 5'-i �< . _.-.i
Notice Sent to Pubtic: �� � ���y� Ward #: o�
DepaRmentJ Date lnspections Commerts
City Attorney
5
Environmental
Health
� .�
Fire
Jr ! "�L��` 0 • 7 � •
License Siee Plan Received:_
I.ease Received:
���� �� �!�
Police
�O`L� c7•� '
Zoning
���{ `�'�- �. �• .
MAR-19-1997 11:08 CITY OF ST PRUL LIEP
_.�
.
CT.ASS III crrX oF sanvr pnu[,
o�«�t.;�,r�a;eK
LICENSB APPL�CATION �a���
i � : ������
��.� ��
��5��v"c�'t�z' ��t �oao `�o��, `�t�''° �'3�� `������,�6
�s �ttc �i�� , � ' S 4�ii��� `�'� !, �f�at.�� c�.$
PLEASE'i'YPE ORPRINI' IlV II�IIC ��
I'cpe of License(s) being app&ed for:
CampffiyName: ..Z�.t.�'! � FF WlL R.l (.Y�
C4rpoMiiou /PaLHS�hip / Sote Aaprictnnhip
If business is incorporated, gve date of incoiporation: _
lloia8 $usiness As: � R. � �l �
g�A�: qa5 t2A-�l.�,ve
G -•
seeec aaa�m �+�r
Between what cross �ts is the busiuess located? _
Are tix pren�ises now occupied7 �'hat Type ofBusiness?
r� ro a.aa��: .� O B U1G t!,(UU S'C Le �c i N��t
s�a aae�. c;r
x�,e sna r�u�:
��
ar,aau
Home Address:
caraza��
- sa<aaaane Gry s�uc Zsp
Date of Binh; 1( ��s - l� '� Place of $lrth: Aome Phone:�a4 f. 3 S7 ���,�
Have you ever been com�cted of anq feIocry, crzuu os viol�ion of any city ordizsance other than �c? YES _ IQO �_
D�te of azrest: Whete7
Charge:
Convictioa: Seataia:
I.ist dx nsmes �d �dences of three peisons of good moral charsetcr, living within the Twin Cities Meiro Area, not rdated to the applicant
or finrvcially interested in ffie premi�s or business, who may be r�f�ed to as to t�e app3icanYs characfer:
NAME ADDRESS PHONE
��tt�� ll�e�,�it,� S— 1�(7� 0—yaND S7:S .�t-�}��- G,11-`�13L-s3�7
Lold, formcly hc1d, or
Have an} of the abovc n�ed
f� J7 �v N
�I�ta Gl -
Ftave an lAfei'C,t Ip:
612 266 9124 P.
s TU?��/
.S ii
S t Ui
s I ;��'�;
�33
�► V �'� AS� 1kNd -�-NC-
-36
Busiaess Fhon� 12 �a' � 2l �o
,IT �/ srio�'
s� z�,
Which side of the strect�
u l�ti y0S/'2._
� � �
�V.4�vr f 9�r�i�t � �
� r�x
°.1_.1.�v t►J.
been revokedP YES � NO If y�s, list the dates �d reasons tor revocatioa:
2/18N9
i9`7 11�08 C1TY OF ST PRUL LIEP 612 266 9124 P.04i06
/ a e-�3
operrse this busiaess pesonally? � cS _,�L..� 130 If nob �rho u-iU operEte ��IPERAMERICAG1�lilll�
7� Dntc o
.t f�a��� ' ��Zr�ii"���p
Slck 2ip Pkro:+o:�3cnbes
Pkzu list your ernplrnmen! history fer we prc�la.0 5ve (5) cezr period:
Bus�nesslEtqpirn Address
iafo;mation for eaeh parmer (use additional pages if aecesssffiy):
Fita�sme
Home Addreu 5vaes \mse City Swc Zip Phone?�mba
Fcu\ame .W'iddleiaitd (.�Lidrn1 T.ast DefeefBatb
HoneAd6ia�t� Sma2'.cue Gry Stau Zip 3Yneee?.`umbet
MINIr'E507A TAX IDSNTffICATION NEJMBER - P�usuaat to 4x La�rs of DSnaesota,1984, Chapta 502, Article 8, SEM�on 2{270.72)
(Ta� Cle�nce; Issusnoe of Licenses). T�cnsing suthmities are rec��ed to pmende to tbe State of 2+/u�aesota Commissi�er of Reveaiu. tt�e
M'wnaota bw�aess tsx id�aafication numbet aod the social securiry a�ber of each licease applicant.
Uuder the Mmaeso+a Go�amncat Dats Pr�tias Aa aud �e Fedarl Aicacp Ad of f 97d, we sre rcquir� to advise you of the foIlaw�iug
regazcimg the use �'t6e M�esota TaxI�cation isvmba:
-?his i�mati� may be uscd W ckuq the:n a reaewat of ymu Eicc¢sc in the cvcat you owe l�umesota sates, employe� s
witbholdmg a mM� ve3ricle exase taxe�
' UP°n r�v�8 tlus infacrostioa, tlie Iicwsiag au4priry w�l supply it onty W t� Mumesota Dcpatuaeat of Rtvenue. However,
unda tbe Federal FxcLauge af Information A�t, tbe Departman of Revenue maY �PPtY this inf'ormatian m tfie Intttasl
Reveaue Seiiri,x.
M� Tau IdmUSeatiaatNumbas (Sales & Us�?Ex Numba') may be ob�med &� tBe S�ate ofM�� B�� �� �Pmimau.
lORivaParkPlaza fb12-296-6181} _ .. . -
�� s�� r��:.� /— O ! �a-�S G-_ �� r�x �,�c�� rr,mm�: !� �3 �SS
_ Jf a D+&aaesota Fsx Identi5carioa Nvmba is aot requ�cd for the businas bemg opaated, indicau so by placing aa'X' ia ihe box
�„e��
pse c� �g tnfizre a�g� oresss.�c ia this husiness? ✓�S NO 7f the ma:�zger is not the seme �s tLe operator,
p}exse wmplete che follouiag
yist zll uther o�cas of the co:po�tion:
pF�iCER TI'I�.E HO?vt6 H0� Bi7SL�*ESS DATEOF
?.*4?�,iF (OffixHekl] . ADIl�ESS PHO�'E PHOATE BIILTH
Council File ¢ - ` �b
ordinance #
Green Sheet # �✓ ✓
RESOLUTION
�� � � '- �..,,. O� INT PAUL, MINNESOTA �)
[.� v �
Presented By
Re£erred To
Committee: Date
1 RESOLVED: That application (ID #98886) for a Gas Station, Restaurant-D, Crrocery-C, and Cigazette License by
z Super America Group Division of Asliland DBA SupetAmerica #4419 (Clayton Bleske, Manager)
3 at 925 Grand Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs se
7 B a�kekev —
9 Har� � Off�ce of L,icense Insg�ctions and
10 M r � Environmental Protection -
11
12 T une
14 Morton —�' / I,� ��
15 � By. I� �-y i
16 Adopted by Council: Date �$ qq �
17
1S Adoption Certified by Council Secretary
19 Form Approved by City Atto�
20
21 By:
22 BY '
23 Approved by Mayor: Date 4� �/��--
24
zs r Approved by Mayor for Submission to
26 $y. (�,_ Council
27
By: _
�"�b3�
D PApTMEMT/OFFICFJCOUNCIL DATEINRIATED GREEN SHEE N� 35323
LIEPfLicensin — -"
CpNTACT PEp50N & PHONE � p � A �� p��QqN1ilAVDATE O CITY COUNCIL INITIALIDATE
Christine RoZek 266-9108 "�'�" � crtvnrroaNer � cmc�aK
MUST BE ON fAUNCIL AGENDA BY (OATE) pp�MpG� � BUOGET �IRECTOR � FIN. & MGT. SERVICES DIR.
Z /� ORDER � Mpypp (OR ASSISTANn �
For hearin : �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATONS FOR SIGNATURE)
ACTION iiC-0UE5TED:
The SuperAmerica Group Division ot Ashland DBA SuperAmerica 9t4419 requests Council approval
of its application for a Gas Staiton, Res[aurant-D, Grocery-C, and Cigarette I.icense at
925 Grand Avenue (ID 9t98886).
aECOMMENDAT�ONS: Apqove (A) or Reiea (R) PERSONAL SERVICE CONTRACTS MUST ANSWER 7HE FOILOWING QVESTIONS:
_ PLANNING CAMMISSION _ CIVIL SEflV10E COMMISSION �� Has ihis persoNfirm ever wo�ketl untler a conVaci for this tlepadment? -
_ c�e caaMmEe _ vES - NO
2. Has this personfirm ever 6een a city employee?
_ STAFF — YES NO
_ Dis7piCT CAUq7 _ 3. Does this pereoNfirm possess a skill not nortnall �
y po5sessed by any current city employee.
SUPPOfiTSWHICHCOUNCILOBJECTIVEI YES NO
Expiafn all yes answers on separate sheet and attach to 9�� eneet
INRIATING PROBLEM, ISSUE, OPPORTUNI7Y(Who. WM1at, When, Where, Why)
ADVANTAGES IF APPROVED:
DISADVANTAQES IFAPPROVED:
�s3�"��{� �.,�°��Z�v�` R�eR�§�
��i,�s�' �, � t��$
DISADVANTAdES IF NO�APPROVED:
TOTAL AMOUNi OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOUNCE ACTIVITY NUMBEq
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35323 L.I.E.P. REVIEW CHECKLIST Date: 3127197 � S�
In Tf3Ckel? App'n qeceived / App'n Processed
LiCenselD # 98886 License Type: Gas Station, Restaurant-D, Grocerv-C, and Ciearette
Company Name:SuperAmerica Grou➢ Division of Ashland DBA: SunerAmerica 414419_ __
BUSiness Addresss: 925 Grand Avenue Susiness Phone: " 222-7216
Contact Name/Address: Clavton Bleske, 925 Grand Ave 105 Home Phone:
Date to Council Research:
Public Hearing Date:� � 2 �
Notice Sent to AppiicaM: -� �
�, �, .-r..f
Labels Ordered: y�
District Couocil #: ��
p C 5'-i �< . _.-.i
Notice Sent to Pubtic: �� � ���y� Ward #: o�
DepaRmentJ Date lnspections Commerts
City Attorney
5
Environmental
Health
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Fire
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License Siee Plan Received:_
I.ease Received:
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Police
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Zoning
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MAR-19-1997 11:08 CITY OF ST PRUL LIEP
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LICENSB APPL�CATION �a���
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PLEASE'i'YPE ORPRINI' IlV II�IIC ��
I'cpe of License(s) being app&ed for:
CampffiyName: ..Z�.t.�'! � FF WlL R.l (.Y�
C4rpoMiiou /PaLHS�hip / Sote Aaprictnnhip
If business is incorporated, gve date of incoiporation: _
lloia8 $usiness As: � R. � �l �
g�A�: qa5 t2A-�l.�,ve
G -•
seeec aaa�m �+�r
Between what cross �ts is the busiuess located? _
Are tix pren�ises now occupied7 �'hat Type ofBusiness?
r� ro a.aa��: .� O B U1G t!,(UU S'C Le �c i N��t
s�a aae�. c;r
x�,e sna r�u�:
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ar,aau
Home Address:
caraza��
- sa<aaaane Gry s�uc Zsp
Date of Binh; 1( ��s - l� '� Place of $lrth: Aome Phone:�a4 f. 3 S7 ���,�
Have you ever been com�cted of anq feIocry, crzuu os viol�ion of any city ordizsance other than �c? YES _ IQO �_
D�te of azrest: Whete7
Charge:
Convictioa: Seataia:
I.ist dx nsmes �d �dences of three peisons of good moral charsetcr, living within the Twin Cities Meiro Area, not rdated to the applicant
or finrvcially interested in ffie premi�s or business, who may be r�f�ed to as to t�e app3icanYs characfer:
NAME ADDRESS PHONE
��tt�� ll�e�,�it,� S— 1�(7� 0—yaND S7:S .�t-�}��- G,11-`�13L-s3�7
Lold, formcly hc1d, or
Have an} of the abovc n�ed
f� J7 �v N
�I�ta Gl -
Ftave an lAfei'C,t Ip:
612 266 9124 P.
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Busiaess Fhon� 12 �a' � 2l �o
,IT �/ srio�'
s� z�,
Which side of the strect�
u l�ti y0S/'2._
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�V.4�vr f 9�r�i�t � �
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been revokedP YES � NO If y�s, list the dates �d reasons tor revocatioa:
2/18N9
i9`7 11�08 C1TY OF ST PRUL LIEP 612 266 9124 P.04i06
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operrse this busiaess pesonally? � cS _,�L..� 130 If nob �rho u-iU operEte ��IPERAMERICAG1�lilll�
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.t f�a��� ' ��Zr�ii"���p
Slck 2ip Pkro:+o:�3cnbes
Pkzu list your ernplrnmen! history fer we prc�la.0 5ve (5) cezr period:
Bus�nesslEtqpirn Address
iafo;mation for eaeh parmer (use additional pages if aecesssffiy):
Fita�sme
Home Addreu 5vaes \mse City Swc Zip Phone?�mba
Fcu\ame .W'iddleiaitd (.�Lidrn1 T.ast DefeefBatb
HoneAd6ia�t� Sma2'.cue Gry Stau Zip 3Yneee?.`umbet
MINIr'E507A TAX IDSNTffICATION NEJMBER - P�usuaat to 4x La�rs of DSnaesota,1984, Chapta 502, Article 8, SEM�on 2{270.72)
(Ta� Cle�nce; Issusnoe of Licenses). T�cnsing suthmities are rec��ed to pmende to tbe State of 2+/u�aesota Commissi�er of Reveaiu. tt�e
M'wnaota bw�aess tsx id�aafication numbet aod the social securiry a�ber of each licease applicant.
Uuder the Mmaeso+a Go�amncat Dats Pr�tias Aa aud �e Fedarl Aicacp Ad of f 97d, we sre rcquir� to advise you of the foIlaw�iug
regazcimg the use �'t6e M�esota TaxI�cation isvmba:
-?his i�mati� may be uscd W ckuq the:n a reaewat of ymu Eicc¢sc in the cvcat you owe l�umesota sates, employe� s
witbholdmg a mM� ve3ricle exase taxe�
' UP°n r�v�8 tlus infacrostioa, tlie Iicwsiag au4priry w�l supply it onty W t� Mumesota Dcpatuaeat of Rtvenue. However,
unda tbe Federal FxcLauge af Information A�t, tbe Departman of Revenue maY �PPtY this inf'ormatian m tfie Intttasl
Reveaue Seiiri,x.
M� Tau IdmUSeatiaatNumbas (Sales & Us�?Ex Numba') may be ob�med &� tBe S�ate ofM�� B�� �� �Pmimau.
lORivaParkPlaza fb12-296-6181} _ .. . -
�� s�� r��:.� /— O ! �a-�S G-_ �� r�x �,�c�� rr,mm�: !� �3 �SS
_ Jf a D+&aaesota Fsx Identi5carioa Nvmba is aot requ�cd for the businas bemg opaated, indicau so by placing aa'X' ia ihe box
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pse c� �g tnfizre a�g� oresss.�c ia this husiness? ✓�S NO 7f the ma:�zger is not the seme �s tLe operator,
p}exse wmplete che follouiag
yist zll uther o�cas of the co:po�tion:
pF�iCER TI'I�.E HO?vt6 H0� Bi7SL�*ESS DATEOF
?.*4?�,iF (OffixHekl] . ADIl�ESS PHO�'E PHOATE BIILTH