97-638council File � �� `^�
Ordinance #
Green Sheet # � �3/7
` - ° • RESOLUTfAN
_ CITY OF SAINT PAUL, MINNESOTA S/
f�
Presented By
Referred To
co�nic2ee: uace
1 RESOLVED: That application (ID #40618) for a Cias Station, Restaurant-C, Crrocery-C, and Cigarette License by
z Super America Grwp Division of Ashland DBA SuperAmerica #4038 (Tom Kohloff, Manager) aY
3 390 Maryland Avenue East be and the same is hereby apprrned
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a�Tcep -
8 Bostrom �_ Office of License InsgPCtions and
9 Hasras
0 Per� � Environmental Protect�on
1 ma�s �
2 T une
4 Morton
5 '� �
6 Adopted by Council: Date ° 8 $Y '
7
8 Adoption Certified by Council Secretary
9 Form Approved by City Attorney
0
1 By: By. ' �
2 �
3 Approved by Mayor: Date �- 7�j �'
4
5 Approved by Mayor for Submission to
6 By:
( Council
7
Bye
q"��.'?�g
�PA�„��Tro����� DATEINfTIATED GREEN SHEE N_ 35317
LZEPJLicensin - --
CONTACT PEFiSON & PHONE a DEPARiMEM DIRECfOR O CT' CqUNdL �Nmp1ApTE
Christine Rozek 266-9108 "�'�" �CITYATTORNEY aCffYCLERK
MUST 6E ON COUNCIL AGENDA BY (DA7E) p�� � BUDGET DIRECTO a FlN. & MGT, SERVICES DIR.
r'OI hearin : `' �� �� OXDER �MAVOFl(ORASSIS7APIn �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNANRE)
ACTION fiEQUE5TED:
The SuperAmerica 6roup Division of Ashland DBA SuperAmerica 9P4038 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License at
390 Maryland Avenue East (ID �f4�618). •
RECOMMENDAttaNS: Approve (A) or Rajea (R) pEpSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLIOWING QUESTONS:
_ PLANNMG COMMISSION _ CML SERVICE COMMISSION �� Has this persoMirm ever worked under a conhact tor Mis department? -
_ CIB COMMI7TEE _ YES NO
—�� — 2. Has this person/firm ever been a city employee?
YES IJO
� OIS7RIC7 COUR7 — 3. Does this persontttrm possess a skilf not nmmai city �
N D�essed by am curtem emPlMee.
Sl1PPORTSWHICHCWNCIIOeJECTNE4 YES NO
Explein ell yes anawers on sepnrate sMet and altech to green sheat
INITIATING PROBLEM, ISSUE, OPPfJflTUNITY (WFw. Wliaq When, Where, Why):
ADVANTAGES �F APPROVED'
DISADVANTA(iES IFAPPROVED:
���t5��6 �,;3t^�s�ye' �;�`��¢'
fY�f�`� 3.2 7��iJ
DISADVANTAGESIFNOTAPPROVED: ��� �,
MAY 12 1991
�OE Ct7�.u�a
TO7AL AMOUNT OF TRANSACTION $ COST/qEVENUE BUDGETED (CIRCLE ON� VES NO
fUNDING SOURCE ACTIVI7Y NUMBER
FINANCIAL INFORMATION: (EXPIAIN)
Greensheet # 35317 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 ���'b3SS
4n Trackef? aPp'n Received / app'n �rocessed
license 1D # 40618 License Type: Gas Station, Restaurant-C. Grocerv-C. Cig�rette
Company Name:SuperAmerica Group Div of Ashland DBA: SunerAmerica ��4038
Business Addresss: 390 Marvland Avenue East Business Phone: 774-7270
Contact NamejAddress: Tom Kohloff, 390 Mar�land Ave E Home Phone:
Date to Gouncil Research: 55101
Public Hearing Date: �� ��-- Labefs Ordered: ��
Notice SeM to
Notice Sent to
Department/
City Attomey
Date Inspections
Z •
Environmental
Health
-v�•Z`��-
W � ►'t '
Fire
License
Police
Zoning
��
oistrict counofl #: 5
Ward #: �
Commenis
d•�
Site Plan Received:_
Lease Received:
� � v � �( 1
�•2.•��
�(�
D. � ,
-f�" ��•� •
MPR-19-1997 11-08
i
c
CITY OF ST PA!,iL LIEP
612 266 9124 P.02/06
� �n �n / S: c 11r''�o�
C�-ASS T,II CITY OF SAINT PAtJI�
��of •
�LiG�:�SEArF7_.ICATION . �����
A i : ,������
� � � ����z.
�c�ky�u ��ot � �oao, ���. � � ��,
�tsr�aaLrc ���� 5��t� �ffa7.d,��',rif*fr�-�
PTFeC ETYPEORPR7NI'INR�TIC �a
F}pe ofLiceose(s) bev� applied for:
Compsny Name: J�}� ]��,14 {'Vl � t�.l L�
Corpor�tioa /Pa�tnrs�tdp / Sok Pmpriamsleip
If tiusinas is incotporated, give date o€ inco:posation: _
� s�,� as: ._.S.Se..�:� R. �1 •t '
��Aaar�: ( 9U _.�Ti1�1/j2�
Betwan what ccc�ss ss�teets is the b�uess locat��
Aie �hc premises now �upied? W}tat Type ofBusiness?
� Ta �: P o �..�iu r �ruu� �� �
��
Neme sud Tidc:
s���`A�
�--a� -36
�a3� 8��� ��a
s� /__ .rs.o�
ctty s� z�p
Which side ofthe sne:z?
! IV��G+V � VOS/'Z--
c�Ty sw� y�,,
/^_`, . ' - — i• . / .n .
(Ma�aw) F�a r;}� '
xo� Aaa��: � G Q G /�� t f U d d`
s�a naa�� c;� n.,� �,
Date ofBirth; 1 ���—(� Piace of $irth: Home Phoae:bd L�� 13
Fiave yov ever bern com§cted of saq feloiay, crime or violat�on of any ciry ordinance other ihan traffic? YES _ NO�_
Dau of aFresc: Where7
��&�
Coaviction; Seacex�a;
1.ist ti�nvzra and �sidences of t5tte persons of good mora! charac[a, Gving within the Twiu Cifles Me�o Area, ao[ mlazed to rhe apglicant
rn' financistly interested ia ihe premises or business, who may bc rcfared to as to tLe applicauYs cbaracter:
Q N.e.lvlE ADDRESS /� p � PHON /
V��� ���, S"� y 7� Q—ya�/V �.�.5 ./`-!'i"7/I� ro�.Z• T.3b'•
�A M CH r'�V Cr � 1A -!bR 1� t 4�A. S� iV 1v - AsGtu Rn.` wL-{uv t ��. L, 33-�1
�
Have au�'of the abov� named
�
i�� i�:
YES � NO if yes, list tBe data and reasons for revocatioa:
2/I8N9
i•WR-19-1997 11�08 CITY �F ST PR Ut_ LIEP 612 266 9124 P.04/06
- �t"1�b�S
Are }�ou Saiag to operuc iSis business pcisonally? 1'ES � NO If not, �rho w apa2Ie ��PER F1ME�L'1� C'ijQa��
F�Icx.LL.'rae: str�\a�e C:.y statc
G
P]czsc list your emplo;meat histoty for the prccso:ic five (5};
�y,�''� �eS£
i5 E
infv:meaon for each parmer (use aaditionsl pages if nsxssazy):
Fira\ame waawimou �.-•�•••••y — .. .
27o�eAddroe Svdz\rnc Ctt5 Swc Z:R Fnmo?5�&r
Fia\ssx \�iddl<Foitial (�3ridm) L.at D�eofBath
Hoae.4ddrut' Strat?:me Ciry Stau Zip Phouo?.4�mbe�
MINtr'ESO7A TAX IDENT1fICA'FION NEJMBER - P�usuant to tt�e Isus of M»esots,1984, Chspter 502, Article 8, Section Z(270.72)
(Ta� Clemancc; Issuana ofLicenses),llcrosing authorides fre reqe�ed to provido to t3e State of Mtnaesota Commissi�er of Reveaeu, the
M�wnesota busiaess tax idarri5cation numbex aad the soeisl sxuriry rn�ber of each &cr�se applicaat
Undei �he 2v&naesota C*w�mme�t Daca Praaices Aa �d rba fcdarl Priracy Act of 797a, we ffie requircd to a3oise you of the iollaw
regarding tho use oftfie Mumaota Tax Ideutification NumSa:
- Ihis infamatien may lx used to daaq t1x issuaaa � reaewaf ofyotff fiaasa in the evan you owe Mumcsots salas. emplo5'� s
withholdmg or mo� vchic]e exase t�cc�
- �F� �'+BS 4ris iufaamaaon, tfie lice¢sing autf�iry w�71 suppl3' it oaly a tfie Mwnesaea 1�e.Parmeat of Reventx. However,
undec the Federal ExcL�ge of �nformatioa Agreamcat, tSe DePartmeat of Rcvenue maY �PPF3' this i�oratation to ilu 5rteraal
Revewx Seivicc- - -
M�as iax Id�tiGcat�c�Numbas Csales & Use T�+cNum}Xr) msY be � i� tLe Stste of Mnaesota, Bus;ness Rccor3s Dep� tu,ent.
10 }tiva Perk Pleza (612-2%6181� . . . -
s�� s�cy r��: �L/�� /�-�-�5 C1 _�n� r�x ia��vo� x�n�: -!.� 3 c�.S _
Tf a M�anesota Tax Idunificaaoa Num6a is not requi:� fa tLe businas bcing operated, indicate so by pleciag aa'X" ia ihe box
on e,e-,
Are raa g�, to ��e n cazotger or esssxac ia this business? _�,G. yEg ;d0 If she maaxger is not the sEme fs tbe operator,
List zll ottier o5�as of the oo:po: etion:
��� TT� �p?� HOVE BUSL�*ESS DATE OF
:RA2vf�,� (�ceHe)d? � ADI�SS PHOVE PHO� 'BII2TH
council File � �� `^�
Ordinance #
Green Sheet # � �3/7
` - ° • RESOLUTfAN
_ CITY OF SAINT PAUL, MINNESOTA S/
f�
Presented By
Referred To
co�nic2ee: uace
1 RESOLVED: That application (ID #40618) for a Cias Station, Restaurant-C, Crrocery-C, and Cigarette License by
z Super America Grwp Division of Ashland DBA SuperAmerica #4038 (Tom Kohloff, Manager) aY
3 390 Maryland Avenue East be and the same is hereby apprrned
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a�Tcep -
8 Bostrom �_ Office of License InsgPCtions and
9 Hasras
0 Per� � Environmental Protect�on
1 ma�s �
2 T une
4 Morton
5 '� �
6 Adopted by Council: Date ° 8 $Y '
7
8 Adoption Certified by Council Secretary
9 Form Approved by City Attorney
0
1 By: By. ' �
2 �
3 Approved by Mayor: Date �- 7�j �'
4
5 Approved by Mayor for Submission to
6 By:
( Council
7
Bye
q"��.'?�g
�PA�„��Tro����� DATEINfTIATED GREEN SHEE N_ 35317
LZEPJLicensin - --
CONTACT PEFiSON & PHONE a DEPARiMEM DIRECfOR O CT' CqUNdL �Nmp1ApTE
Christine Rozek 266-9108 "�'�" �CITYATTORNEY aCffYCLERK
MUST 6E ON COUNCIL AGENDA BY (DA7E) p�� � BUDGET DIRECTO a FlN. & MGT, SERVICES DIR.
r'OI hearin : `' �� �� OXDER �MAVOFl(ORASSIS7APIn �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNANRE)
ACTION fiEQUE5TED:
The SuperAmerica 6roup Division of Ashland DBA SuperAmerica 9P4038 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License at
390 Maryland Avenue East (ID �f4�618). •
RECOMMENDAttaNS: Approve (A) or Rajea (R) pEpSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLIOWING QUESTONS:
_ PLANNMG COMMISSION _ CML SERVICE COMMISSION �� Has this persoMirm ever worked under a conhact tor Mis department? -
_ CIB COMMI7TEE _ YES NO
—�� — 2. Has this person/firm ever been a city employee?
YES IJO
� OIS7RIC7 COUR7 — 3. Does this persontttrm possess a skilf not nmmai city �
N D�essed by am curtem emPlMee.
Sl1PPORTSWHICHCWNCIIOeJECTNE4 YES NO
Explein ell yes anawers on sepnrate sMet and altech to green sheat
INITIATING PROBLEM, ISSUE, OPPfJflTUNITY (WFw. Wliaq When, Where, Why):
ADVANTAGES �F APPROVED'
DISADVANTA(iES IFAPPROVED:
���t5��6 �,;3t^�s�ye' �;�`��¢'
fY�f�`� 3.2 7��iJ
DISADVANTAGESIFNOTAPPROVED: ��� �,
MAY 12 1991
�OE Ct7�.u�a
TO7AL AMOUNT OF TRANSACTION $ COST/qEVENUE BUDGETED (CIRCLE ON� VES NO
fUNDING SOURCE ACTIVI7Y NUMBER
FINANCIAL INFORMATION: (EXPIAIN)
Greensheet # 35317 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 ���'b3SS
4n Trackef? aPp'n Received / app'n �rocessed
license 1D # 40618 License Type: Gas Station, Restaurant-C. Grocerv-C. Cig�rette
Company Name:SuperAmerica Group Div of Ashland DBA: SunerAmerica ��4038
Business Addresss: 390 Marvland Avenue East Business Phone: 774-7270
Contact NamejAddress: Tom Kohloff, 390 Mar�land Ave E Home Phone:
Date to Gouncil Research: 55101
Public Hearing Date: �� ��-- Labefs Ordered: ��
Notice SeM to
Notice Sent to
Department/
City Attomey
Date Inspections
Z •
Environmental
Health
-v�•Z`��-
W � ►'t '
Fire
License
Police
Zoning
��
oistrict counofl #: 5
Ward #: �
Commenis
d•�
Site Plan Received:_
Lease Received:
� � v � �( 1
�•2.•��
�(�
D. � ,
-f�" ��•� •
MPR-19-1997 11-08
i
c
CITY OF ST PA!,iL LIEP
612 266 9124 P.02/06
� �n �n / S: c 11r''�o�
C�-ASS T,II CITY OF SAINT PAtJI�
��of •
�LiG�:�SEArF7_.ICATION . �����
A i : ,������
� � � ����z.
�c�ky�u ��ot � �oao, ���. � � ��,
�tsr�aaLrc ���� 5��t� �ffa7.d,��',rif*fr�-�
PTFeC ETYPEORPR7NI'INR�TIC �a
F}pe ofLiceose(s) bev� applied for:
Compsny Name: J�}� ]��,14 {'Vl � t�.l L�
Corpor�tioa /Pa�tnrs�tdp / Sok Pmpriamsleip
If tiusinas is incotporated, give date o€ inco:posation: _
� s�,� as: ._.S.Se..�:� R. �1 •t '
��Aaar�: ( 9U _.�Ti1�1/j2�
Betwan what ccc�ss ss�teets is the b�uess locat��
Aie �hc premises now �upied? W}tat Type ofBusiness?
� Ta �: P o �..�iu r �ruu� �� �
��
Neme sud Tidc:
s���`A�
�--a� -36
�a3� 8��� ��a
s� /__ .rs.o�
ctty s� z�p
Which side ofthe sne:z?
! IV��G+V � VOS/'Z--
c�Ty sw� y�,,
/^_`, . ' - — i• . / .n .
(Ma�aw) F�a r;}� '
xo� Aaa��: � G Q G /�� t f U d d`
s�a naa�� c;� n.,� �,
Date ofBirth; 1 ���—(� Piace of $irth: Home Phoae:bd L�� 13
Fiave yov ever bern com§cted of saq feloiay, crime or violat�on of any ciry ordinance other ihan traffic? YES _ NO�_
Dau of aFresc: Where7
��&�
Coaviction; Seacex�a;
1.ist ti�nvzra and �sidences of t5tte persons of good mora! charac[a, Gving within the Twiu Cifles Me�o Area, ao[ mlazed to rhe apglicant
rn' financistly interested ia ihe premises or business, who may bc rcfared to as to tLe applicauYs cbaracter:
Q N.e.lvlE ADDRESS /� p � PHON /
V��� ���, S"� y 7� Q—ya�/V �.�.5 ./`-!'i"7/I� ro�.Z• T.3b'•
�A M CH r'�V Cr � 1A -!bR 1� t 4�A. S� iV 1v - AsGtu Rn.` wL-{uv t ��. L, 33-�1
�
Have au�'of the abov� named
�
i�� i�:
YES � NO if yes, list tBe data and reasons for revocatioa:
2/I8N9
i•WR-19-1997 11�08 CITY �F ST PR Ut_ LIEP 612 266 9124 P.04/06
- �t"1�b�S
Are }�ou Saiag to operuc iSis business pcisonally? 1'ES � NO If not, �rho w apa2Ie ��PER F1ME�L'1� C'ijQa��
F�Icx.LL.'rae: str�\a�e C:.y statc
G
P]czsc list your emplo;meat histoty for the prccso:ic five (5};
�y,�''� �eS£
i5 E
infv:meaon for each parmer (use aaditionsl pages if nsxssazy):
Fira\ame waawimou �.-•�•••••y — .. .
27o�eAddroe Svdz\rnc Ctt5 Swc Z:R Fnmo?5�&r
Fia\ssx \�iddl<Foitial (�3ridm) L.at D�eofBath
Hoae.4ddrut' Strat?:me Ciry Stau Zip Phouo?.4�mbe�
MINtr'ESO7A TAX IDENT1fICA'FION NEJMBER - P�usuant to tt�e Isus of M»esots,1984, Chspter 502, Article 8, Section Z(270.72)
(Ta� Clemancc; Issuana ofLicenses),llcrosing authorides fre reqe�ed to provido to t3e State of Mtnaesota Commissi�er of Reveaeu, the
M�wnesota busiaess tax idarri5cation numbex aad the soeisl sxuriry rn�ber of each &cr�se applicaat
Undei �he 2v&naesota C*w�mme�t Daca Praaices Aa �d rba fcdarl Priracy Act of 797a, we ffie requircd to a3oise you of the iollaw
regarding tho use oftfie Mumaota Tax Ideutification NumSa:
- Ihis infamatien may lx used to daaq t1x issuaaa � reaewaf ofyotff fiaasa in the evan you owe Mumcsots salas. emplo5'� s
withholdmg or mo� vchic]e exase t�cc�
- �F� �'+BS 4ris iufaamaaon, tfie lice¢sing autf�iry w�71 suppl3' it oaly a tfie Mwnesaea 1�e.Parmeat of Reventx. However,
undec the Federal ExcL�ge of �nformatioa Agreamcat, tSe DePartmeat of Rcvenue maY �PPF3' this i�oratation to ilu 5rteraal
Revewx Seivicc- - -
M�as iax Id�tiGcat�c�Numbas Csales & Use T�+cNum}Xr) msY be � i� tLe Stste of Mnaesota, Bus;ness Rccor3s Dep� tu,ent.
10 }tiva Perk Pleza (612-2%6181� . . . -
s�� s�cy r��: �L/�� /�-�-�5 C1 _�n� r�x ia��vo� x�n�: -!.� 3 c�.S _
Tf a M�anesota Tax Idunificaaoa Num6a is not requi:� fa tLe businas bcing operated, indicate so by pleciag aa'X" ia ihe box
on e,e-,
Are raa g�, to ��e n cazotger or esssxac ia this business? _�,G. yEg ;d0 If she maaxger is not the sEme fs tbe operator,
List zll ottier o5�as of the oo:po: etion:
��� TT� �p?� HOVE BUSL�*ESS DATE OF
:RA2vf�,� (�ceHe)d? � ADI�SS PHOVE PHO� 'BII2TH
council File � �� `^�
Ordinance #
Green Sheet # � �3/7
` - ° • RESOLUTfAN
_ CITY OF SAINT PAUL, MINNESOTA S/
f�
Presented By
Referred To
co�nic2ee: uace
1 RESOLVED: That application (ID #40618) for a Cias Station, Restaurant-C, Crrocery-C, and Cigarette License by
z Super America Grwp Division of Ashland DBA SuperAmerica #4038 (Tom Kohloff, Manager) aY
3 390 Maryland Avenue East be and the same is hereby apprrned
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a�Tcep -
8 Bostrom �_ Office of License InsgPCtions and
9 Hasras
0 Per� � Environmental Protect�on
1 ma�s �
2 T une
4 Morton
5 '� �
6 Adopted by Council: Date ° 8 $Y '
7
8 Adoption Certified by Council Secretary
9 Form Approved by City Attorney
0
1 By: By. ' �
2 �
3 Approved by Mayor: Date �- 7�j �'
4
5 Approved by Mayor for Submission to
6 By:
( Council
7
Bye
q"��.'?�g
�PA�„��Tro����� DATEINfTIATED GREEN SHEE N_ 35317
LZEPJLicensin - --
CONTACT PEFiSON & PHONE a DEPARiMEM DIRECfOR O CT' CqUNdL �Nmp1ApTE
Christine Rozek 266-9108 "�'�" �CITYATTORNEY aCffYCLERK
MUST 6E ON COUNCIL AGENDA BY (DA7E) p�� � BUDGET DIRECTO a FlN. & MGT, SERVICES DIR.
r'OI hearin : `' �� �� OXDER �MAVOFl(ORASSIS7APIn �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNANRE)
ACTION fiEQUE5TED:
The SuperAmerica 6roup Division of Ashland DBA SuperAmerica 9P4038 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License at
390 Maryland Avenue East (ID �f4�618). •
RECOMMENDAttaNS: Approve (A) or Rajea (R) pEpSONAL SERVICE CONTRACTS MUST ANSWER TNE FOLIOWING QUESTONS:
_ PLANNMG COMMISSION _ CML SERVICE COMMISSION �� Has this persoMirm ever worked under a conhact tor Mis department? -
_ CIB COMMI7TEE _ YES NO
—�� — 2. Has this person/firm ever been a city employee?
YES IJO
� OIS7RIC7 COUR7 — 3. Does this persontttrm possess a skilf not nmmai city �
N D�essed by am curtem emPlMee.
Sl1PPORTSWHICHCWNCIIOeJECTNE4 YES NO
Explein ell yes anawers on sepnrate sMet and altech to green sheat
INITIATING PROBLEM, ISSUE, OPPfJflTUNITY (WFw. Wliaq When, Where, Why):
ADVANTAGES �F APPROVED'
DISADVANTA(iES IFAPPROVED:
���t5��6 �,;3t^�s�ye' �;�`��¢'
fY�f�`� 3.2 7��iJ
DISADVANTAGESIFNOTAPPROVED: ��� �,
MAY 12 1991
�OE Ct7�.u�a
TO7AL AMOUNT OF TRANSACTION $ COST/qEVENUE BUDGETED (CIRCLE ON� VES NO
fUNDING SOURCE ACTIVI7Y NUMBER
FINANCIAL INFORMATION: (EXPIAIN)
Greensheet # 35317 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 ���'b3SS
4n Trackef? aPp'n Received / app'n �rocessed
license 1D # 40618 License Type: Gas Station, Restaurant-C. Grocerv-C. Cig�rette
Company Name:SuperAmerica Group Div of Ashland DBA: SunerAmerica ��4038
Business Addresss: 390 Marvland Avenue East Business Phone: 774-7270
Contact NamejAddress: Tom Kohloff, 390 Mar�land Ave E Home Phone:
Date to Gouncil Research: 55101
Public Hearing Date: �� ��-- Labefs Ordered: ��
Notice SeM to
Notice Sent to
Department/
City Attomey
Date Inspections
Z •
Environmental
Health
-v�•Z`��-
W � ►'t '
Fire
License
Police
Zoning
��
oistrict counofl #: 5
Ward #: �
Commenis
d•�
Site Plan Received:_
Lease Received:
� � v � �( 1
�•2.•��
�(�
D. � ,
-f�" ��•� •
MPR-19-1997 11-08
i
c
CITY OF ST PA!,iL LIEP
612 266 9124 P.02/06
� �n �n / S: c 11r''�o�
C�-ASS T,II CITY OF SAINT PAtJI�
��of •
�LiG�:�SEArF7_.ICATION . �����
A i : ,������
� � � ����z.
�c�ky�u ��ot � �oao, ���. � � ��,
�tsr�aaLrc ���� 5��t� �ffa7.d,��',rif*fr�-�
PTFeC ETYPEORPR7NI'INR�TIC �a
F}pe ofLiceose(s) bev� applied for:
Compsny Name: J�}� ]��,14 {'Vl � t�.l L�
Corpor�tioa /Pa�tnrs�tdp / Sok Pmpriamsleip
If tiusinas is incotporated, give date o€ inco:posation: _
� s�,� as: ._.S.Se..�:� R. �1 •t '
��Aaar�: ( 9U _.�Ti1�1/j2�
Betwan what ccc�ss ss�teets is the b�uess locat��
Aie �hc premises now �upied? W}tat Type ofBusiness?
� Ta �: P o �..�iu r �ruu� �� �
��
Neme sud Tidc:
s���`A�
�--a� -36
�a3� 8��� ��a
s� /__ .rs.o�
ctty s� z�p
Which side ofthe sne:z?
! IV��G+V � VOS/'Z--
c�Ty sw� y�,,
/^_`, . ' - — i• . / .n .
(Ma�aw) F�a r;}� '
xo� Aaa��: � G Q G /�� t f U d d`
s�a naa�� c;� n.,� �,
Date ofBirth; 1 ���—(� Piace of $irth: Home Phoae:bd L�� 13
Fiave yov ever bern com§cted of saq feloiay, crime or violat�on of any ciry ordinance other ihan traffic? YES _ NO�_
Dau of aFresc: Where7
��&�
Coaviction; Seacex�a;
1.ist ti�nvzra and �sidences of t5tte persons of good mora! charac[a, Gving within the Twiu Cifles Me�o Area, ao[ mlazed to rhe apglicant
rn' financistly interested ia ihe premises or business, who may bc rcfared to as to tLe applicauYs cbaracter:
Q N.e.lvlE ADDRESS /� p � PHON /
V��� ���, S"� y 7� Q—ya�/V �.�.5 ./`-!'i"7/I� ro�.Z• T.3b'•
�A M CH r'�V Cr � 1A -!bR 1� t 4�A. S� iV 1v - AsGtu Rn.` wL-{uv t ��. L, 33-�1
�
Have au�'of the abov� named
�
i�� i�:
YES � NO if yes, list tBe data and reasons for revocatioa:
2/I8N9
i•WR-19-1997 11�08 CITY �F ST PR Ut_ LIEP 612 266 9124 P.04/06
- �t"1�b�S
Are }�ou Saiag to operuc iSis business pcisonally? 1'ES � NO If not, �rho w apa2Ie ��PER F1ME�L'1� C'ijQa��
F�Icx.LL.'rae: str�\a�e C:.y statc
G
P]czsc list your emplo;meat histoty for the prccso:ic five (5};
�y,�''� �eS£
i5 E
infv:meaon for each parmer (use aaditionsl pages if nsxssazy):
Fira\ame waawimou �.-•�•••••y — .. .
27o�eAddroe Svdz\rnc Ctt5 Swc Z:R Fnmo?5�&r
Fia\ssx \�iddl<Foitial (�3ridm) L.at D�eofBath
Hoae.4ddrut' Strat?:me Ciry Stau Zip Phouo?.4�mbe�
MINtr'ESO7A TAX IDENT1fICA'FION NEJMBER - P�usuant to tt�e Isus of M»esots,1984, Chspter 502, Article 8, Section Z(270.72)
(Ta� Clemancc; Issuana ofLicenses),llcrosing authorides fre reqe�ed to provido to t3e State of Mtnaesota Commissi�er of Reveaeu, the
M�wnesota busiaess tax idarri5cation numbex aad the soeisl sxuriry rn�ber of each &cr�se applicaat
Undei �he 2v&naesota C*w�mme�t Daca Praaices Aa �d rba fcdarl Priracy Act of 797a, we ffie requircd to a3oise you of the iollaw
regarding tho use oftfie Mumaota Tax Ideutification NumSa:
- Ihis infamatien may lx used to daaq t1x issuaaa � reaewaf ofyotff fiaasa in the evan you owe Mumcsots salas. emplo5'� s
withholdmg or mo� vchic]e exase t�cc�
- �F� �'+BS 4ris iufaamaaon, tfie lice¢sing autf�iry w�71 suppl3' it oaly a tfie Mwnesaea 1�e.Parmeat of Reventx. However,
undec the Federal ExcL�ge of �nformatioa Agreamcat, tSe DePartmeat of Rcvenue maY �PPF3' this i�oratation to ilu 5rteraal
Revewx Seivicc- - -
M�as iax Id�tiGcat�c�Numbas Csales & Use T�+cNum}Xr) msY be � i� tLe Stste of Mnaesota, Bus;ness Rccor3s Dep� tu,ent.
10 }tiva Perk Pleza (612-2%6181� . . . -
s�� s�cy r��: �L/�� /�-�-�5 C1 _�n� r�x ia��vo� x�n�: -!.� 3 c�.S _
Tf a M�anesota Tax Idunificaaoa Num6a is not requi:� fa tLe businas bcing operated, indicate so by pleciag aa'X" ia ihe box
on e,e-,
Are raa g�, to ��e n cazotger or esssxac ia this business? _�,G. yEg ;d0 If she maaxger is not the sEme fs tbe operator,
List zll ottier o5�as of the oo:po: etion:
��� TT� �p?� HOVE BUSL�*ESS DATE OF
:RA2vf�,� (�ceHe)d? � ADI�SS PHOVE PHO� 'BII2TH