97-644Council File # _\�`o`�
ordinance #
Green Sheet # � �
Presented By
Referred To
MINNESOTA b�
Committee: Date
1 RESOLVED: That application (ID #30759) for a Gas Station, Restaw�ant-C, Grocery-C, and Cigazette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4001(Charlene Goldschmidt,
3 Manager) at 296 7th Street East be and the same is hereby approved
4
5 Requested by Department of:
6 Yeas Navs s nt
7 B a e�ky -
S Bost�m � Office of License In�p Qctions and
9 Harris
10 M a d nvironmental Protection
11 i�� �
14 Morton �-
15 � � By: �}�� �'� ���,t,��
16 Adopted by Council: Date
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 /� 21 By: a �� �-�
22 / -` ���A��c�i1� li l.�-On.ci
23 Approved by Mayor: Date � lS 1- J
24
25 A Approved by Mayor for Submission to
Z6 BY� � �;/L Council
z7
By:
o� b�ky
DEMNi1AENiADFFlCE/CAUNGIL DATE INITIATED J f�J L V
LIEP/Licensing GREEN SHEE
CON7ACT PERSON & PHONE �NRIAUDATE INITIAVDATE
� OEPARiMENi DIRECiOR � CiTY COUNCIt
Chxistine Rozek, 266-9108 ASSIGN �CfSYAT(ORTIEY �CRYCLEflK
NUYBERFOA
MUST BE ON COUNCIL AGEI7[lA BV (DATc7� /� p�M� O gUWET DIRECTO � FlN. & MGi. SEAVICES DIR.
For hearing: � 2� \ OPUEP �MpyOFi(ORASSISTANn �
TOTAL # OF SIGISASURE PAGES (CLIP ALL LOCATfONS FOR SIGNATURE)
ACTION fiEQUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 1�4001 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License located
at 246 7th Sereet East (ID i13�759).
RECOMMENDAT70NS: Appmve (A) or Reject (R) pERSONAL SERVICE CONTHACTS MUS7 ANSWER THE FOLLOWING QUESTIONS:
_ P(ANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever worketl under a contrect for this department?
_ qB CAMMITTEE _ YES NO
_ STnFf 2. Has thfs pereon�rm ever been a ciry employee?
— YES NO
_ DISTRICT CWR7 _ 3. Does this persoMvm possess a skill not normally pos5essed by any current ciry employee7
SUPPORTS WHICH CAONCIL O&IECTIVE? YES NO
Explafn all yes answers on saparate sheet antl attach to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (Who, Whet, When, Where, Why).
ADVANTAGES IFAPPROVED:
DISAOVANTAGES IF APPROVEO.
$a^r- - - `.`" ��.
6e �..t..�.., ,_..,,a..._.�68 .,,�_
G�,; r,� �. � 6��l
s,.rz i
..�..��.-_._._..�_,. �.�.e��S:.wr -
OISADVANTAGES IF NOTAPPROVED:
70iAL AMOUNT OF TRANSAC710N S COST/REVENUE BUDGE7E0 (CIRCLE ONE) YES NO
FUNOIfdG SOURCE ACTIVITY NUMBER
FMANpAL INFORRnAT10N� (EXPLAIN)
Greensheet # 37928 L.I.E.P. REVIEW CHECKLIST Date: 3127l97 G�'�°
In Tracker? APP'� �erved I EWP'� ���
LicenselD # 30759 Ucense Type:�as Station, Restaurant-C, Grocery-C, and Cigarette Licen
COmp2ny Name: S�erAmerica Gioup Division of Ashland DBA: SuperAmerica 4�4001
Business Addresss: 296 7th Street East Business Phone: Z25-9567
Contact Name/Address: Charlene Goldschmidt. 296 7th E, 101 Home Phone:
Date to Council Research:
Public Hearing Date: � �
Notice Serrt to Applicant:
.� . r,�rn
n
labels Ordered: l�
Districi Councii #: � �
v;r'/ prJ
tJotice Sern to Pubiic: �k�� � �/� Ward #: �
Departmentf Date Inspections Comments
City Attorney
`�•Zc�j•9� p.� ,
Environmental
Heaith
� • i'� '
Fire
o. K. .
�icense ��e �� ������—
Lease aeceived:
E� �(j� „ � � 1 �
✓ O
Police
�-( • z8' `��' O•1C •
2oning
� ' {'� `
MRR-19-1997 11�08
�
612 266 9124 P.02/06
CLASS Z3I CI?'Y OF SAINT PAUx.
o`Si« of t;«aq Im�xCiois
LICENSE APPLICATION � � ��
A I �or � ��� �"�°:�
� �
��c ��vDt � ¢oao, �4�3, � � 4�� (61�7bb9Vi0&x�6.�S6E9176
3g � � � 5 ��'� �a.r, �s, �
�s � ic��i� i� �'3d
PLEASE TYPE OR PK1NT IN Rv'K
2}pe of Liceose(s) be;� appfied for:
Ca.np�y Ns[ne:
If business is incorporate3, �ve date of incozpor�ion:
Doiag Business As: S IA �'� �� �1
a�� naar�: 3�� �.S'T _ 7
so-<a add�su ciry
Betwan what cross strcels is the bvsiness located�
Az� the presnises now accu 'A' What T G of Bvsmess?
Mail Ta Address: � V y �,V X! L��V C 7 � C� 1� f IV �
�Addre.s � Crc
Appiicsnz Infom
Na�ne mzd Tifle:
S
S `t�a�
i
,y
BusiaessPhone:rel�- S� S(e�
►�cj ,..�.v s-rio�
Stam Zip
Wlucit side of the sIIret?
N°f. y
(� (Maz�l Iaa Tisk �
Homeqddress; ���1 l� �,(��} d �
svea aem�,n c;ey s� Z;p
T?ate of Birth: 1���-(� "� Place of $inh: Home Pbone�a6 ` 3 S7 �� 13
Have you ever been cAmlcud of anp fcloizy, crime or violacion of any ary o;dinance other than tra�c? Y£S _ NO „�_
Dste of mresc: WLere7
��&G
Coaviction: Sentmce:
List dKnames �diesidences of ttu�ce persons of good moral chm�actcr, fi�vig within the Twin Cities Ivfeiro Area, not mlated to the applicant
Ot {Ia�Gia�y iilteCeSted iAlfie pien]ises Or busi4ess, tvho m8y bt rtfccred io as W ttAe appISCant's Ch8i8Ctei:
Nf1ME ADDRESS PHONE
Ba�d nllo�;� s- i`172 o-�1aNO sT.s .,��,ti (�i�•y3�s,�3T
,a�v cH J�e�►H - �taR)-�g�. s� ivw -.v�w �n.; L,-t.�• _��a- b33-��Yy
CITY OF ST PflUL LIEP
�-aa.-
_
;�:
��
r�oked7
YES � NO Ifyes, list the daas snd reasons foz nwocation:
2/28�9!
H�� �F� 9124
612 266 9124
. .
'.� ..
YES � NO Ifr,o., �cho a�i11 eperate " ��—`►��
s� � I PE R A Ag E R I G'A t; j p P Yl P
��;�� Divi �
L�at br, n--. "'_— _ ---
•:�.�am� �y-ea�u�e
Arc r�a � to I�.xc•e a nzaE� or rss"s;zat in this bt:r:ness? _1C YES
P�� cQ.�pE��e cbe folloccing i�,
�u
s
'. Ccl
Pkzse list yo� miplo}aeni kustory for the pre�no�u ,:ve (5) 3'ez*period:
B�s'v*�eSS�Eifloloc.-nent
If b ' is t
`Q
F;ra:.ame
Home,4�i5
C��eden)
i.�u �
STctc y� �� �
L'`R Dam �
Statc 7:�. ed_ .
�TA TAX IDE?3IIfICATION NUMgER . P�us�aQt to the i.aWs of 2�iia•�eso
(T� Clwrance; lssuaaa ofLicenseaj, $c,�s�g a ��ri� ffie �, 7 984, CSspta 502, Article 8, Sxtioa 2(270.72)
Mmnespta buriness tax identifica5on rnimba and the social �ed eo provide to c4e State ofMsoaes�ta Commissi�er ofReveavq the
sxurity aumber of czck Iicasse aPPlicsat
i7ader tfie �tz Govanmmt Data Pradices Aa �d tbe Federa! Pricary Act of i 974, we are nquired to advise you of� follau�g
reS8�n8 the use oftfie h�nesoca T�c Identi&calion Numba:
�ith�ol�' � be vsu2 to dcuy tLe ;«„s..�. �. reaewa! ofyacY iiceusc ia the evem you owe M�uaesota sal
� �8 motor vehicla excise taxe� es. �pIayei s
� 1� �i�'�8 tl�s iufocmadon, the licensiag acR�iry tv� �ppFy it oalp a tfie Musnesota DeP�t of Revrnve. Homev�.
vnda the F�ast Exr3mige of Infermadoa A�� the DepaRmene oY Roveaue may wPP�Y � infoimafion to the Iateraal
Revenur Seri�ica
?vf�mx�a Ta�c I�cat;cg Nua,bets (sales �. use rax rhtt�3�Y� o�r�ea ff� s5e stau orIvl�nnesot� Busiuess Records U�ep�mau.
10 ��'aPsrk Plaze (6I?�296-6181�
Socia] Sxurity N�azcba: �O �� U ��.1.'1 t' /� �e�in Tax IdattiScaGon Nem�ber. =�a 7aC ^� �S s
— Ife NFinaesoea Ta�c IdentiScaDac Nwsba is not requized far ihe businas being operato� iadicau w
b5' Pie�g aa'X" in �6e box
�
S•.a}c �
:•�O If the mzazg� is r.o� the srne Es tbe ope,rafor,
- ` Dsc
✓� �S/0� j�►1 9w�
info:mation for each pa (use addiaonal pages if asxss�y).
�
,,, s,._
OFF7CER TlTZ.E HO?vi$
:•A.� (OffiaHa ) � ,q��SS kIO.V,� BiSSL'�'ESS DATE OF
!0 D i4!' n PHO\'E PHOA� $IRTH
Council File # _\�`o`�
ordinance #
Green Sheet # � �
Presented By
Referred To
MINNESOTA b�
Committee: Date
1 RESOLVED: That application (ID #30759) for a Gas Station, Restaw�ant-C, Grocery-C, and Cigazette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4001(Charlene Goldschmidt,
3 Manager) at 296 7th Street East be and the same is hereby approved
4
5 Requested by Department of:
6 Yeas Navs s nt
7 B a e�ky -
S Bost�m � Office of License In�p Qctions and
9 Harris
10 M a d nvironmental Protection
11 i�� �
14 Morton �-
15 � � By: �}�� �'� ���,t,��
16 Adopted by Council: Date
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 /� 21 By: a �� �-�
22 / -` ���A��c�i1� li l.�-On.ci
23 Approved by Mayor: Date � lS 1- J
24
25 A Approved by Mayor for Submission to
Z6 BY� � �;/L Council
z7
By:
o� b�ky
DEMNi1AENiADFFlCE/CAUNGIL DATE INITIATED J f�J L V
LIEP/Licensing GREEN SHEE
CON7ACT PERSON & PHONE �NRIAUDATE INITIAVDATE
� OEPARiMENi DIRECiOR � CiTY COUNCIt
Chxistine Rozek, 266-9108 ASSIGN �CfSYAT(ORTIEY �CRYCLEflK
NUYBERFOA
MUST BE ON COUNCIL AGEI7[lA BV (DATc7� /� p�M� O gUWET DIRECTO � FlN. & MGi. SEAVICES DIR.
For hearing: � 2� \ OPUEP �MpyOFi(ORASSISTANn �
TOTAL # OF SIGISASURE PAGES (CLIP ALL LOCATfONS FOR SIGNATURE)
ACTION fiEQUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 1�4001 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License located
at 246 7th Sereet East (ID i13�759).
RECOMMENDAT70NS: Appmve (A) or Reject (R) pERSONAL SERVICE CONTHACTS MUS7 ANSWER THE FOLLOWING QUESTIONS:
_ P(ANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever worketl under a contrect for this department?
_ qB CAMMITTEE _ YES NO
_ STnFf 2. Has thfs pereon�rm ever been a ciry employee?
— YES NO
_ DISTRICT CWR7 _ 3. Does this persoMvm possess a skill not normally pos5essed by any current ciry employee7
SUPPORTS WHICH CAONCIL O&IECTIVE? YES NO
Explafn all yes answers on saparate sheet antl attach to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (Who, Whet, When, Where, Why).
ADVANTAGES IFAPPROVED:
DISAOVANTAGES IF APPROVEO.
$a^r- - - `.`" ��.
6e �..t..�.., ,_..,,a..._.�68 .,,�_
G�,; r,� �. � 6��l
s,.rz i
..�..��.-_._._..�_,. �.�.e��S:.wr -
OISADVANTAGES IF NOTAPPROVED:
70iAL AMOUNT OF TRANSAC710N S COST/REVENUE BUDGE7E0 (CIRCLE ONE) YES NO
FUNOIfdG SOURCE ACTIVITY NUMBER
FMANpAL INFORRnAT10N� (EXPLAIN)
Greensheet # 37928 L.I.E.P. REVIEW CHECKLIST Date: 3127l97 G�'�°
In Tracker? APP'� �erved I EWP'� ���
LicenselD # 30759 Ucense Type:�as Station, Restaurant-C, Grocery-C, and Cigarette Licen
COmp2ny Name: S�erAmerica Gioup Division of Ashland DBA: SuperAmerica 4�4001
Business Addresss: 296 7th Street East Business Phone: Z25-9567
Contact Name/Address: Charlene Goldschmidt. 296 7th E, 101 Home Phone:
Date to Council Research:
Public Hearing Date: � �
Notice Serrt to Applicant:
.� . r,�rn
n
labels Ordered: l�
Districi Councii #: � �
v;r'/ prJ
tJotice Sern to Pubiic: �k�� � �/� Ward #: �
Departmentf Date Inspections Comments
City Attorney
`�•Zc�j•9� p.� ,
Environmental
Heaith
� • i'� '
Fire
o. K. .
�icense ��e �� ������—
Lease aeceived:
E� �(j� „ � � 1 �
✓ O
Police
�-( • z8' `��' O•1C •
2oning
� ' {'� `
MRR-19-1997 11�08
�
612 266 9124 P.02/06
CLASS Z3I CI?'Y OF SAINT PAUx.
o`Si« of t;«aq Im�xCiois
LICENSE APPLICATION � � ��
A I �or � ��� �"�°:�
� �
��c ��vDt � ¢oao, �4�3, � � 4�� (61�7bb9Vi0&x�6.�S6E9176
3g � � � 5 ��'� �a.r, �s, �
�s � ic��i� i� �'3d
PLEASE TYPE OR PK1NT IN Rv'K
2}pe of Liceose(s) be;� appfied for:
Ca.np�y Ns[ne:
If business is incorporate3, �ve date of incozpor�ion:
Doiag Business As: S IA �'� �� �1
a�� naar�: 3�� �.S'T _ 7
so-<a add�su ciry
Betwan what cross strcels is the bvsiness located�
Az� the presnises now accu 'A' What T G of Bvsmess?
Mail Ta Address: � V y �,V X! L��V C 7 � C� 1� f IV �
�Addre.s � Crc
Appiicsnz Infom
Na�ne mzd Tifle:
S
S `t�a�
i
,y
BusiaessPhone:rel�- S� S(e�
►�cj ,..�.v s-rio�
Stam Zip
Wlucit side of the sIIret?
N°f. y
(� (Maz�l Iaa Tisk �
Homeqddress; ���1 l� �,(��} d �
svea aem�,n c;ey s� Z;p
T?ate of Birth: 1���-(� "� Place of $inh: Home Pbone�a6 ` 3 S7 �� 13
Have you ever been cAmlcud of anp fcloizy, crime or violacion of any ary o;dinance other than tra�c? Y£S _ NO „�_
Dste of mresc: WLere7
��&G
Coaviction: Sentmce:
List dKnames �diesidences of ttu�ce persons of good moral chm�actcr, fi�vig within the Twin Cities Ivfeiro Area, not mlated to the applicant
Ot {Ia�Gia�y iilteCeSted iAlfie pien]ises Or busi4ess, tvho m8y bt rtfccred io as W ttAe appISCant's Ch8i8Ctei:
Nf1ME ADDRESS PHONE
Ba�d nllo�;� s- i`172 o-�1aNO sT.s .,��,ti (�i�•y3�s,�3T
,a�v cH J�e�►H - �taR)-�g�. s� ivw -.v�w �n.; L,-t.�• _��a- b33-��Yy
CITY OF ST PflUL LIEP
�-aa.-
_
;�:
��
r�oked7
YES � NO Ifyes, list the daas snd reasons foz nwocation:
2/28�9!
H�� �F� 9124
612 266 9124
. .
'.� ..
YES � NO Ifr,o., �cho a�i11 eperate " ��—`►��
s� � I PE R A Ag E R I G'A t; j p P Yl P
��;�� Divi �
L�at br, n--. "'_— _ ---
•:�.�am� �y-ea�u�e
Arc r�a � to I�.xc•e a nzaE� or rss"s;zat in this bt:r:ness? _1C YES
P�� cQ.�pE��e cbe folloccing i�,
�u
s
'. Ccl
Pkzse list yo� miplo}aeni kustory for the pre�no�u ,:ve (5) 3'ez*period:
B�s'v*�eSS�Eifloloc.-nent
If b ' is t
`Q
F;ra:.ame
Home,4�i5
C��eden)
i.�u �
STctc y� �� �
L'`R Dam �
Statc 7:�. ed_ .
�TA TAX IDE?3IIfICATION NUMgER . P�us�aQt to the i.aWs of 2�iia•�eso
(T� Clwrance; lssuaaa ofLicenseaj, $c,�s�g a ��ri� ffie �, 7 984, CSspta 502, Article 8, Sxtioa 2(270.72)
Mmnespta buriness tax identifica5on rnimba and the social �ed eo provide to c4e State ofMsoaes�ta Commissi�er ofReveavq the
sxurity aumber of czck Iicasse aPPlicsat
i7ader tfie �tz Govanmmt Data Pradices Aa �d tbe Federa! Pricary Act of i 974, we are nquired to advise you of� follau�g
reS8�n8 the use oftfie h�nesoca T�c Identi&calion Numba:
�ith�ol�' � be vsu2 to dcuy tLe ;«„s..�. �. reaewa! ofyacY iiceusc ia the evem you owe M�uaesota sal
� �8 motor vehicla excise taxe� es. �pIayei s
� 1� �i�'�8 tl�s iufocmadon, the licensiag acR�iry tv� �ppFy it oalp a tfie Musnesota DeP�t of Revrnve. Homev�.
vnda the F�ast Exr3mige of Infermadoa A�� the DepaRmene oY Roveaue may wPP�Y � infoimafion to the Iateraal
Revenur Seri�ica
?vf�mx�a Ta�c I�cat;cg Nua,bets (sales �. use rax rhtt�3�Y� o�r�ea ff� s5e stau orIvl�nnesot� Busiuess Records U�ep�mau.
10 ��'aPsrk Plaze (6I?�296-6181�
Socia] Sxurity N�azcba: �O �� U ��.1.'1 t' /� �e�in Tax IdattiScaGon Nem�ber. =�a 7aC ^� �S s
— Ife NFinaesoea Ta�c IdentiScaDac Nwsba is not requized far ihe businas being operato� iadicau w
b5' Pie�g aa'X" in �6e box
�
S•.a}c �
:•�O If the mzazg� is r.o� the srne Es tbe ope,rafor,
- ` Dsc
✓� �S/0� j�►1 9w�
info:mation for each pa (use addiaonal pages if asxss�y).
�
,,, s,._
OFF7CER TlTZ.E HO?vi$
:•A.� (OffiaHa ) � ,q��SS kIO.V,� BiSSL'�'ESS DATE OF
!0 D i4!' n PHO\'E PHOA� $IRTH
Council File # _\�`o`�
ordinance #
Green Sheet # � �
Presented By
Referred To
MINNESOTA b�
Committee: Date
1 RESOLVED: That application (ID #30759) for a Gas Station, Restaw�ant-C, Grocery-C, and Cigazette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4001(Charlene Goldschmidt,
3 Manager) at 296 7th Street East be and the same is hereby approved
4
5 Requested by Department of:
6 Yeas Navs s nt
7 B a e�ky -
S Bost�m � Office of License In�p Qctions and
9 Harris
10 M a d nvironmental Protection
11 i�� �
14 Morton �-
15 � � By: �}�� �'� ���,t,��
16 Adopted by Council: Date
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 /� 21 By: a �� �-�
22 / -` ���A��c�i1� li l.�-On.ci
23 Approved by Mayor: Date � lS 1- J
24
25 A Approved by Mayor for Submission to
Z6 BY� � �;/L Council
z7
By:
o� b�ky
DEMNi1AENiADFFlCE/CAUNGIL DATE INITIATED J f�J L V
LIEP/Licensing GREEN SHEE
CON7ACT PERSON & PHONE �NRIAUDATE INITIAVDATE
� OEPARiMENi DIRECiOR � CiTY COUNCIt
Chxistine Rozek, 266-9108 ASSIGN �CfSYAT(ORTIEY �CRYCLEflK
NUYBERFOA
MUST BE ON COUNCIL AGEI7[lA BV (DATc7� /� p�M� O gUWET DIRECTO � FlN. & MGi. SEAVICES DIR.
For hearing: � 2� \ OPUEP �MpyOFi(ORASSISTANn �
TOTAL # OF SIGISASURE PAGES (CLIP ALL LOCATfONS FOR SIGNATURE)
ACTION fiEQUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 1�4001 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License located
at 246 7th Sereet East (ID i13�759).
RECOMMENDAT70NS: Appmve (A) or Reject (R) pERSONAL SERVICE CONTHACTS MUS7 ANSWER THE FOLLOWING QUESTIONS:
_ P(ANNING COMMISSION _ CIVIL SERVICE COMMISSION �� Has this person/firm ever worketl under a contrect for this department?
_ qB CAMMITTEE _ YES NO
_ STnFf 2. Has thfs pereon�rm ever been a ciry employee?
— YES NO
_ DISTRICT CWR7 _ 3. Does this persoMvm possess a skill not normally pos5essed by any current ciry employee7
SUPPORTS WHICH CAONCIL O&IECTIVE? YES NO
Explafn all yes answers on saparate sheet antl attach to green aheet
INITIATING PROBLEM, ISSUE. OPPORTUNITY (Who, Whet, When, Where, Why).
ADVANTAGES IFAPPROVED:
DISAOVANTAGES IF APPROVEO.
$a^r- - - `.`" ��.
6e �..t..�.., ,_..,,a..._.�68 .,,�_
G�,; r,� �. � 6��l
s,.rz i
..�..��.-_._._..�_,. �.�.e��S:.wr -
OISADVANTAGES IF NOTAPPROVED:
70iAL AMOUNT OF TRANSAC710N S COST/REVENUE BUDGE7E0 (CIRCLE ONE) YES NO
FUNOIfdG SOURCE ACTIVITY NUMBER
FMANpAL INFORRnAT10N� (EXPLAIN)
Greensheet # 37928 L.I.E.P. REVIEW CHECKLIST Date: 3127l97 G�'�°
In Tracker? APP'� �erved I EWP'� ���
LicenselD # 30759 Ucense Type:�as Station, Restaurant-C, Grocery-C, and Cigarette Licen
COmp2ny Name: S�erAmerica Gioup Division of Ashland DBA: SuperAmerica 4�4001
Business Addresss: 296 7th Street East Business Phone: Z25-9567
Contact Name/Address: Charlene Goldschmidt. 296 7th E, 101 Home Phone:
Date to Council Research:
Public Hearing Date: � �
Notice Serrt to Applicant:
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labels Ordered: l�
Districi Councii #: � �
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tJotice Sern to Pubiic: �k�� � �/� Ward #: �
Departmentf Date Inspections Comments
City Attorney
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Environmental
Heaith
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Fire
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Lease aeceived:
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Police
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MRR-19-1997 11�08
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612 266 9124 P.02/06
CLASS Z3I CI?'Y OF SAINT PAUx.
o`Si« of t;«aq Im�xCiois
LICENSE APPLICATION � � ��
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PLEASE TYPE OR PK1NT IN Rv'K
2}pe of Liceose(s) be;� appfied for:
Ca.np�y Ns[ne:
If business is incorporate3, �ve date of incozpor�ion:
Doiag Business As: S IA �'� �� �1
a�� naar�: 3�� �.S'T _ 7
so-<a add�su ciry
Betwan what cross strcels is the bvsiness located�
Az� the presnises now accu 'A' What T G of Bvsmess?
Mail Ta Address: � V y �,V X! L��V C 7 � C� 1� f IV �
�Addre.s � Crc
Appiicsnz Infom
Na�ne mzd Tifle:
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BusiaessPhone:rel�- S� S(e�
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Stam Zip
Wlucit side of the sIIret?
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Homeqddress; ���1 l� �,(��} d �
svea aem�,n c;ey s� Z;p
T?ate of Birth: 1���-(� "� Place of $inh: Home Pbone�a6 ` 3 S7 �� 13
Have you ever been cAmlcud of anp fcloizy, crime or violacion of any ary o;dinance other than tra�c? Y£S _ NO „�_
Dste of mresc: WLere7
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Coaviction: Sentmce:
List dKnames �diesidences of ttu�ce persons of good moral chm�actcr, fi�vig within the Twin Cities Ivfeiro Area, not mlated to the applicant
Ot {Ia�Gia�y iilteCeSted iAlfie pien]ises Or busi4ess, tvho m8y bt rtfccred io as W ttAe appISCant's Ch8i8Ctei:
Nf1ME ADDRESS PHONE
Ba�d nllo�;� s- i`172 o-�1aNO sT.s .,��,ti (�i�•y3�s,�3T
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CITY OF ST PflUL LIEP
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r�oked7
YES � NO Ifyes, list the daas snd reasons foz nwocation:
2/28�9!
H�� �F� 9124
612 266 9124
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YES � NO Ifr,o., �cho a�i11 eperate " ��—`►��
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Arc r�a � to I�.xc•e a nzaE� or rss"s;zat in this bt:r:ness? _1C YES
P�� cQ.�pE��e cbe folloccing i�,
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'. Ccl
Pkzse list yo� miplo}aeni kustory for the pre�no�u ,:ve (5) 3'ez*period:
B�s'v*�eSS�Eifloloc.-nent
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F;ra:.ame
Home,4�i5
C��eden)
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STctc y� �� �
L'`R Dam �
Statc 7:�. ed_ .
�TA TAX IDE?3IIfICATION NUMgER . P�us�aQt to the i.aWs of 2�iia•�eso
(T� Clwrance; lssuaaa ofLicenseaj, $c,�s�g a ��ri� ffie �, 7 984, CSspta 502, Article 8, Sxtioa 2(270.72)
Mmnespta buriness tax identifica5on rnimba and the social �ed eo provide to c4e State ofMsoaes�ta Commissi�er ofReveavq the
sxurity aumber of czck Iicasse aPPlicsat
i7ader tfie �tz Govanmmt Data Pradices Aa �d tbe Federa! Pricary Act of i 974, we are nquired to advise you of� follau�g
reS8�n8 the use oftfie h�nesoca T�c Identi&calion Numba:
�ith�ol�' � be vsu2 to dcuy tLe ;«„s..�. �. reaewa! ofyacY iiceusc ia the evem you owe M�uaesota sal
� �8 motor vehicla excise taxe� es. �pIayei s
� 1� �i�'�8 tl�s iufocmadon, the licensiag acR�iry tv� �ppFy it oalp a tfie Musnesota DeP�t of Revrnve. Homev�.
vnda the F�ast Exr3mige of Infermadoa A�� the DepaRmene oY Roveaue may wPP�Y � infoimafion to the Iateraal
Revenur Seri�ica
?vf�mx�a Ta�c I�cat;cg Nua,bets (sales �. use rax rhtt�3�Y� o�r�ea ff� s5e stau orIvl�nnesot� Busiuess Records U�ep�mau.
10 ��'aPsrk Plaze (6I?�296-6181�
Socia] Sxurity N�azcba: �O �� U ��.1.'1 t' /� �e�in Tax IdattiScaGon Nem�ber. =�a 7aC ^� �S s
— Ife NFinaesoea Ta�c IdentiScaDac Nwsba is not requized far ihe businas being operato� iadicau w
b5' Pie�g aa'X" in �6e box
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S•.a}c �
:•�O If the mzazg� is r.o� the srne Es tbe ope,rafor,
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✓� �S/0� j�►1 9w�
info:mation for each pa (use addiaonal pages if asxss�y).
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OFF7CER TlTZ.E HO?vi$
:•A.� (OffiaHa ) � ,q��SS kIO.V,� BiSSL'�'ESS DATE OF
!0 D i4!' n PHO\'E PHOA� $IRTH