97-645Council File � _ \ ����
ordinance #
Green Sheet # ��
Presented By
1
2
3
Referred To
OF �Altd� PAUL, MINNESOTA
Committee: Date
�3
RESOLVED: TS�at application (ID #48484) for a Gas Station, Restaurant-C, Grocery-C, and Cigareue Li� by
Super America Group Division of Asliland DBA SuperAmerica #4420 (Karen Moore, Manager) at
1125 7th Street West be and the snne is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs een
7 B a e�
8 a Bos�trom Office of License I s�ections and
10 M r a d
nvironment8l Protect�on
11 �a,�Cei�:u�
12 T un�
14 Morton
is 5 0 � /� � �
16 Adopted by Council: Date _�� � �* B Y� l
17
18 Adoption Certified by Council Secretary
19 Form Approoed by City Attorney
20 \
21 By: c-.� c� , �A�e�a/a"' By. -
22 / � ''
23 Approved by Mayor: Date ��
24
zs Approved by Mayor for Submisaion to
26 By: � L Council
27
� By°
q� b�S
n-�n�w
DEPMiIAENLOFFICEACOUNCIL DATE INRIATED J 1 J J J
LIEP/Licensing GREEN SHEE
CONiACi PEASON & PHONE � OEPARTMEM DIRECTORNR�AUDAh � CT' COUNCIL �
Christine Rozek, 266-9108 ��cN �cmarroANev �cmc�aK
NUYBEAFOR
MUSTBE ON fAUNCIL AGENDA 8Y DATE) AOU71lIG � BUOGET�IRECTOR O FIN. & MGT. SERVICES DIR.
For hearing: '� �� OROEq O MqYpR (OR ASSISTANn �
TOTAL # OF SIGNATURE PAGES (CLIP AlL LOCATIONS FOR S16NATURE)
AGTION REQUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 9t4420 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License
located at 1125 7th Street West (ID ��48484).
aECAMMENDAnONS: Appco�e (A) w Re�aet (a) pERSONAL SEpV�CE CONTRACTS MUST ANSWER TXE FOLLOWING QUESTIONS:
_ PLANNING COMMISSIDN _ CIVIL SERVICE COMMISSION �� Has this p8rsonNirm ever worked under a contrect for this tlepartment?
_C18CAMM7TfEE _ YES NO
2. Has Mis perso�rm ever been a ciry employee?
— � — YES NO
_ DiSTRICTCOUR7 _ 3. Does this perso�rm possess a skill not normall
y possessed by any current ciry employee?
SUPPOflT$ WHICH COUNCIL OBJECTIVEI YES NO
Explain all yes answers on separate aheet antl attach to green aheet
INITIATING PROBLEM, ISSUE, OPPGIRTUNITY (Who. What. When, Where, Why):
ADVANTAGES IFAPPROVED:
DISADVANTAGES IFAPPFOVED:
e_" ' .�t,..
...u...�„ ....<., _�,.. .e._ :�.k
k�.r�: � � Ya��
�., ��r�.,:�
OISADVANTAGES IF NOT APPROVEO.
TOTAL AMOUN7 OF TRANSAC710N $ CO57/REVENUE BUDGE7E0 (CIRCLE ONE) YES NO
FUNDIIOG SOUHCE ACTIVI7Y NUMBER
PINANCIAL INFORKiATION' (EXPIAIN)
Greensheet # 37935 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 ��� �O�S
in Tracker? app'n aecerved / app'n arocessea
LicenselD # 48484 License Type: Gas Station, Restaurant—C, Grocery—C, and Ciearette Lice
Company Name: SuperAmerica Group Division of Ashland DBA: G»nPrAmP,-;ra dk449n
Business Addresss: 1125 7th St W Susiness Phone: zz1-1021
Contact NameJAddress: �ren Moore, 1125 7th St W, 102 Home Phone:
Date to Council Research: /
Public Hearing Date: �� Zg � labels Orderecl: G � Q NR
Notice Serrt to Appiiqrn: District Councii #: !
Notice Sent to Pubtic: ��/ �� ���� Ward #: �
Department/ Date Inspections Comments
City Attorney
�'•2 •9�- o, �
Environmental
Heaith
5 2•`"l� L�•�•
Fire
5•Z'�� �3� •
License Site Pian Received:
�a� t���ea:
S' �(t f..l �j �i
t� �1
Police
� � Z •q' �' �� � -
Zoning
�•2��� �'r` .
MAR-19-1997 11�68
612 266
CITSL.QE,_5T PAUL LIEP
CT..-ASS TII CITY OF SAINT PAU[.
o&« ofs:�:, i�p«s«s
, � ; LICENSE APPLICATI4N ����
30gP�u5t5�30D
� ♦ S�PCd SSiO3
� �yy�)�f� � �1 ���0 l����r1" � i" �� (��90967mcf�1669146
Tl�••q • •
TF�i APPLiC �7�S i�4'�'�I`F���3��� � �• �f '► 7�++�
PLFASE'fYPE ORPRINT IN II�: � T � v
Y�pe of License(s) bang aPPlied for:
.
Comgffiy Nawe:
Cocpontiou 1 Y+rtnasdip ! Solz Psoprietontip
If business is incorpaated, give date of incoigoration: ,
��x�,�,�: � e..�3 e Avk.r R� r�
��� aaa��: /! 2S l4,+P s�' '�-f� S�
so-ac wdd�aa crt5'
Betwan what cross suee.is is the busness located?
Are thc premises now ocr. ied7 Whac Type of Business?
� ro aaa��: _...p � g (I1G 1 V�U � 1..e 1� i N4't
�cntm�.. cm
Name m�d Tido:
s T!/f.4-
s b.� F. U D
r ;. • ,.. ^ �"Rl!I��J�
s� �
WviC12 side of dx StrfGt?
n... �
—•----__ _ _
Fvu � .'N'idmc (Maidm) Is+t Yuk
�
HOIDC A�LCSS: �� I.� vd! f� U O Q �
Sputt.d&cs Ciry SWc Zip
Aate of $irth: 1� ��S _(� Place of Binh: Home Pnonelaa 1. 3 S7 � Z 13
Ha�e you ever been comlcc� of aztg felony, aime or violadon ofany city ordinance other than traffic? YES � NO �_
Date of a�resc: Where7
Charge:
Coavictiau: 5entmcc:
List drnauxs andresidenoes of three petsoas of good moral chm�actcr, living wzthin the Twiu Cilies Metro Area, aot srlatcd to the applicant
or fiasnciall} interested in thepremises ar bwiness, who msy bc icfared to as to tiae appSicanYs charaeter:
AIt1ME _n ADDRESS PHONE
��t.Rd l� 10�t.1 S" 14 7� 0-daN D S'�S .�} ���- 11- y36-S.T3 �
_ !'�N�� '�� � �A14l���� ST N� " ����/1`��� b�� 633-�1-Yy
�
Have aus�'of the above named
���77��
� , � ., i
,:t`�:�� .� .�
V j�/ I
have an
YES � NO If ye; list tlu dse�s �ct �asons foz revocerion:
21t8�97
MAR-19-1357 11=08 CI7y nF „ST PA�- LIEP 612 266 9124 P.04i06
°�'�rb�l�
1.se cou Roin� :a oPezYlc this busiAess p�°n�'� YES �;3o Ff not, «'ho w9U op«ate ��fIPER AMERICAGROIJ�
p,Kr� go¢eg to �e a�tger or ess.�zat in this business? YES :�0 If th� msaager is na the same ts tbe apecator,
Pkzse listyour emp3o;ment kustory for the prc��o:zs five (5) c•eu period:
: /E lo�xn t Address
is e Parm4shiP, P]er,se iaclude jhe £olly��ing info:mavoa fac each parma (use additionat gages if necessary)�
xv.�eadd� saxc�e Cnr su�e Zia x,o��SmsQ
Fcs.\mc ?Sid9ctoi6d (-�3u&a) Laa Datcef$atb
lioxRddrac Scea!wmo Ccy Sute Zip Phox;.'umba
MIt�TAES07A TAX IDENI7FiCt+1'ION NUMBER - P�t w the Isws of �ota,1984, Chapta 502, Article 8, Sxtion 2(270.72?
(Tae Cieermce, Issusaee ofLicw,es).liaasing suthorities are req�ed to provide to tbe State of Mmnesota Cammissioner of Revenu�, the
NGunaota bzuiaess tax idmtifica2ion wmba aad thc social securiry armmber of cach licaue appHcant
Uuder tfie M�aaesota Govamneat Data Praci'sces Aa �si she F�dar1 Pricacy Act of t 974, we sre required to ad�ise you of the follaa�ing
regard'mg the use ofthe 2vlumesota Tsc Ideottificafion Numba:
- I3is infamatia� msy be e�sed to dez� tLe issvana or reaewal of yrnu fianse in the eveat you owe Mumcsota sa]es, empIoyei s
wrthhole3vig a mot�'vdricle exase t�ce�
' UP°a r�vm8 4ds info�mseoa. tFie Gcemia8 �ry ��PPig it oalp W tfie �a LkParment of Fteveaue. Howe�er,
unda the Fedaet ExcLmzge of Infocatatioa A�� the Dq>�tment of Rcveaue maS su�FlS this int"ormslian w the rnteraa3
Reveaue Savice. - -
Mmar�ta SaxIdmUScffiic�Numbe:s (Swlcs &TJse Tax Nuwba�)may Ix o� &om tbe State of Nf�nncsote, Business Rxc.or3s Dep�tment.
70RivrrParkPlazs(612-2%-618!} .. _ ..... _.
s��t s��yr�a�:.��3 ,! a-a-�S G �� r�ia�ns�u�rr��: -!� �:� ��
! lf a I�fanesota Ta�c ]drntificarioa 1+7nmbc is not regu:ued for tLe businas being operated, indicato so by placing an'X" ia �e box
..,, e �,-,
Lis� zll other o�eers af the c�po: eGon:
p�� TT� $p?vIF� HOVi£ BUSL�'ESS DATEOF
:..r+.�. tO�aaHe}d) � ADI}RESS PHO�'E PHOIv'E BIRTH
Council File � _ \ ����
ordinance #
Green Sheet # ��
Presented By
1
2
3
Referred To
OF �Altd� PAUL, MINNESOTA
Committee: Date
�3
RESOLVED: TS�at application (ID #48484) for a Gas Station, Restaurant-C, Grocery-C, and Cigareue Li� by
Super America Group Division of Asliland DBA SuperAmerica #4420 (Karen Moore, Manager) at
1125 7th Street West be and the snne is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs een
7 B a e�
8 a Bos�trom Office of License I s�ections and
10 M r a d
nvironment8l Protect�on
11 �a,�Cei�:u�
12 T un�
14 Morton
is 5 0 � /� � �
16 Adopted by Council: Date _�� � �* B Y� l
17
18 Adoption Certified by Council Secretary
19 Form Approoed by City Attorney
20 \
21 By: c-.� c� , �A�e�a/a"' By. -
22 / � ''
23 Approved by Mayor: Date ��
24
zs Approved by Mayor for Submisaion to
26 By: � L Council
27
� By°
q� b�S
n-�n�w
DEPMiIAENLOFFICEACOUNCIL DATE INRIATED J 1 J J J
LIEP/Licensing GREEN SHEE
CONiACi PEASON & PHONE � OEPARTMEM DIRECTORNR�AUDAh � CT' COUNCIL �
Christine Rozek, 266-9108 ��cN �cmarroANev �cmc�aK
NUYBEAFOR
MUSTBE ON fAUNCIL AGENDA 8Y DATE) AOU71lIG � BUOGET�IRECTOR O FIN. & MGT. SERVICES DIR.
For hearing: '� �� OROEq O MqYpR (OR ASSISTANn �
TOTAL # OF SIGNATURE PAGES (CLIP AlL LOCATIONS FOR S16NATURE)
AGTION REQUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 9t4420 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License
located at 1125 7th Street West (ID ��48484).
aECAMMENDAnONS: Appco�e (A) w Re�aet (a) pERSONAL SEpV�CE CONTRACTS MUST ANSWER TXE FOLLOWING QUESTIONS:
_ PLANNING COMMISSIDN _ CIVIL SERVICE COMMISSION �� Has this p8rsonNirm ever worked under a contrect for this tlepartment?
_C18CAMM7TfEE _ YES NO
2. Has Mis perso�rm ever been a ciry employee?
— � — YES NO
_ DiSTRICTCOUR7 _ 3. Does this perso�rm possess a skill not normall
y possessed by any current ciry employee?
SUPPOflT$ WHICH COUNCIL OBJECTIVEI YES NO
Explain all yes answers on separate aheet antl attach to green aheet
INITIATING PROBLEM, ISSUE, OPPGIRTUNITY (Who. What. When, Where, Why):
ADVANTAGES IFAPPROVED:
DISADVANTAGES IFAPPFOVED:
e_" ' .�t,..
...u...�„ ....<., _�,.. .e._ :�.k
k�.r�: � � Ya��
�., ��r�.,:�
OISADVANTAGES IF NOT APPROVEO.
TOTAL AMOUN7 OF TRANSAC710N $ CO57/REVENUE BUDGE7E0 (CIRCLE ONE) YES NO
FUNDIIOG SOUHCE ACTIVI7Y NUMBER
PINANCIAL INFORKiATION' (EXPIAIN)
Greensheet # 37935 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 ��� �O�S
in Tracker? app'n aecerved / app'n arocessea
LicenselD # 48484 License Type: Gas Station, Restaurant—C, Grocery—C, and Ciearette Lice
Company Name: SuperAmerica Group Division of Ashland DBA: G»nPrAmP,-;ra dk449n
Business Addresss: 1125 7th St W Susiness Phone: zz1-1021
Contact NameJAddress: �ren Moore, 1125 7th St W, 102 Home Phone:
Date to Council Research: /
Public Hearing Date: �� Zg � labels Orderecl: G � Q NR
Notice Serrt to Appiiqrn: District Councii #: !
Notice Sent to Pubtic: ��/ �� ���� Ward #: �
Department/ Date Inspections Comments
City Attorney
�'•2 •9�- o, �
Environmental
Heaith
5 2•`"l� L�•�•
Fire
5•Z'�� �3� •
License Site Pian Received:
�a� t���ea:
S' �(t f..l �j �i
t� �1
Police
� � Z •q' �' �� � -
Zoning
�•2��� �'r` .
MAR-19-1997 11�68
612 266
CITSL.QE,_5T PAUL LIEP
CT..-ASS TII CITY OF SAINT PAU[.
o&« ofs:�:, i�p«s«s
, � ; LICENSE APPLICATI4N ����
30gP�u5t5�30D
� ♦ S�PCd SSiO3
� �yy�)�f� � �1 ���0 l����r1" � i" �� (��90967mcf�1669146
Tl�••q • •
TF�i APPLiC �7�S i�4'�'�I`F���3��� � �• �f '► 7�++�
PLFASE'fYPE ORPRINT IN II�: � T � v
Y�pe of License(s) bang aPPlied for:
.
Comgffiy Nawe:
Cocpontiou 1 Y+rtnasdip ! Solz Psoprietontip
If business is incorpaated, give date of incoigoration: ,
��x�,�,�: � e..�3 e Avk.r R� r�
��� aaa��: /! 2S l4,+P s�' '�-f� S�
so-ac wdd�aa crt5'
Betwan what cross suee.is is the busness located?
Are thc premises now ocr. ied7 Whac Type of Business?
� ro aaa��: _...p � g (I1G 1 V�U � 1..e 1� i N4't
�cntm�.. cm
Name m�d Tido:
s T!/f.4-
s b.� F. U D
r ;. • ,.. ^ �"Rl!I��J�
s� �
WviC12 side of dx StrfGt?
n... �
—•----__ _ _
Fvu � .'N'idmc (Maidm) Is+t Yuk
�
HOIDC A�LCSS: �� I.� vd! f� U O Q �
Sputt.d&cs Ciry SWc Zip
Aate of $irth: 1� ��S _(� Place of Binh: Home Pnonelaa 1. 3 S7 � Z 13
Ha�e you ever been comlcc� of aztg felony, aime or violadon ofany city ordinance other than traffic? YES � NO �_
Date of a�resc: Where7
Charge:
Coavictiau: 5entmcc:
List drnauxs andresidenoes of three petsoas of good moral chm�actcr, living wzthin the Twiu Cilies Metro Area, aot srlatcd to the applicant
or fiasnciall} interested in thepremises ar bwiness, who msy bc icfared to as to tiae appSicanYs charaeter:
AIt1ME _n ADDRESS PHONE
��t.Rd l� 10�t.1 S" 14 7� 0-daN D S'�S .�} ���- 11- y36-S.T3 �
_ !'�N�� '�� � �A14l���� ST N� " ����/1`��� b�� 633-�1-Yy
�
Have aus�'of the above named
���77��
� , � ., i
,:t`�:�� .� .�
V j�/ I
have an
YES � NO If ye; list tlu dse�s �ct �asons foz revocerion:
21t8�97
MAR-19-1357 11=08 CI7y nF „ST PA�- LIEP 612 266 9124 P.04i06
°�'�rb�l�
1.se cou Roin� :a oPezYlc this busiAess p�°n�'� YES �;3o Ff not, «'ho w9U op«ate ��fIPER AMERICAGROIJ�
p,Kr� go¢eg to �e a�tger or ess.�zat in this business? YES :�0 If th� msaager is na the same ts tbe apecator,
Pkzse listyour emp3o;ment kustory for the prc��o:zs five (5) c•eu period:
: /E lo�xn t Address
is e Parm4shiP, P]er,se iaclude jhe £olly��ing info:mavoa fac each parma (use additionat gages if necessary)�
xv.�eadd� saxc�e Cnr su�e Zia x,o��SmsQ
Fcs.\mc ?Sid9ctoi6d (-�3u&a) Laa Datcef$atb
lioxRddrac Scea!wmo Ccy Sute Zip Phox;.'umba
MIt�TAES07A TAX IDENI7FiCt+1'ION NUMBER - P�t w the Isws of �ota,1984, Chapta 502, Article 8, Sxtion 2(270.72?
(Tae Cieermce, Issusaee ofLicw,es).liaasing suthorities are req�ed to provide to tbe State of Mmnesota Cammissioner of Revenu�, the
NGunaota bzuiaess tax idmtifica2ion wmba aad thc social securiry armmber of cach licaue appHcant
Uuder tfie M�aaesota Govamneat Data Praci'sces Aa �si she F�dar1 Pricacy Act of t 974, we sre required to ad�ise you of the follaa�ing
regard'mg the use ofthe 2vlumesota Tsc Ideottificafion Numba:
- I3is infamatia� msy be e�sed to dez� tLe issvana or reaewal of yrnu fianse in the eveat you owe Mumcsota sa]es, empIoyei s
wrthhole3vig a mot�'vdricle exase t�ce�
' UP°a r�vm8 4ds info�mseoa. tFie Gcemia8 �ry ��PPig it oalp W tfie �a LkParment of Fteveaue. Howe�er,
unda the Fedaet ExcLmzge of Infocatatioa A�� the Dq>�tment of Rcveaue maS su�FlS this int"ormslian w the rnteraa3
Reveaue Savice. - -
Mmar�ta SaxIdmUScffiic�Numbe:s (Swlcs &TJse Tax Nuwba�)may Ix o� &om tbe State of Nf�nncsote, Business Rxc.or3s Dep�tment.
70RivrrParkPlazs(612-2%-618!} .. _ ..... _.
s��t s��yr�a�:.��3 ,! a-a-�S G �� r�ia�ns�u�rr��: -!� �:� ��
! lf a I�fanesota Ta�c ]drntificarioa 1+7nmbc is not regu:ued for tLe businas being operated, indicato so by placing an'X" ia �e box
..,, e �,-,
Lis� zll other o�eers af the c�po: eGon:
p�� TT� $p?vIF� HOVi£ BUSL�'ESS DATEOF
:..r+.�. tO�aaHe}d) � ADI}RESS PHO�'E PHOIv'E BIRTH
Council File � _ \ ����
ordinance #
Green Sheet # ��
Presented By
1
2
3
Referred To
OF �Altd� PAUL, MINNESOTA
Committee: Date
�3
RESOLVED: TS�at application (ID #48484) for a Gas Station, Restaurant-C, Grocery-C, and Cigareue Li� by
Super America Group Division of Asliland DBA SuperAmerica #4420 (Karen Moore, Manager) at
1125 7th Street West be and the snne is hereby approved.
4
5 Requested by Department of:
6 Yeas Navs een
7 B a e�
8 a Bos�trom Office of License I s�ections and
10 M r a d
nvironment8l Protect�on
11 �a,�Cei�:u�
12 T un�
14 Morton
is 5 0 � /� � �
16 Adopted by Council: Date _�� � �* B Y� l
17
18 Adoption Certified by Council Secretary
19 Form Approoed by City Attorney
20 \
21 By: c-.� c� , �A�e�a/a"' By. -
22 / � ''
23 Approved by Mayor: Date ��
24
zs Approved by Mayor for Submisaion to
26 By: � L Council
27
� By°
q� b�S
n-�n�w
DEPMiIAENLOFFICEACOUNCIL DATE INRIATED J 1 J J J
LIEP/Licensing GREEN SHEE
CONiACi PEASON & PHONE � OEPARTMEM DIRECTORNR�AUDAh � CT' COUNCIL �
Christine Rozek, 266-9108 ��cN �cmarroANev �cmc�aK
NUYBEAFOR
MUSTBE ON fAUNCIL AGENDA 8Y DATE) AOU71lIG � BUOGET�IRECTOR O FIN. & MGT. SERVICES DIR.
For hearing: '� �� OROEq O MqYpR (OR ASSISTANn �
TOTAL # OF SIGNATURE PAGES (CLIP AlL LOCATIONS FOR S16NATURE)
AGTION REQUESTED:
The SuperAmerica Group Division of Ashland DBA SuperAmerica 9t4420 requests Council approval
of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License
located at 1125 7th Street West (ID ��48484).
aECAMMENDAnONS: Appco�e (A) w Re�aet (a) pERSONAL SEpV�CE CONTRACTS MUST ANSWER TXE FOLLOWING QUESTIONS:
_ PLANNING COMMISSIDN _ CIVIL SERVICE COMMISSION �� Has this p8rsonNirm ever worked under a contrect for this tlepartment?
_C18CAMM7TfEE _ YES NO
2. Has Mis perso�rm ever been a ciry employee?
— � — YES NO
_ DiSTRICTCOUR7 _ 3. Does this perso�rm possess a skill not normall
y possessed by any current ciry employee?
SUPPOflT$ WHICH COUNCIL OBJECTIVEI YES NO
Explain all yes answers on separate aheet antl attach to green aheet
INITIATING PROBLEM, ISSUE, OPPGIRTUNITY (Who. What. When, Where, Why):
ADVANTAGES IFAPPROVED:
DISADVANTAGES IFAPPFOVED:
e_" ' .�t,..
...u...�„ ....<., _�,.. .e._ :�.k
k�.r�: � � Ya��
�., ��r�.,:�
OISADVANTAGES IF NOT APPROVEO.
TOTAL AMOUN7 OF TRANSAC710N $ CO57/REVENUE BUDGE7E0 (CIRCLE ONE) YES NO
FUNDIIOG SOUHCE ACTIVI7Y NUMBER
PINANCIAL INFORKiATION' (EXPIAIN)
Greensheet # 37935 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 ��� �O�S
in Tracker? app'n aecerved / app'n arocessea
LicenselD # 48484 License Type: Gas Station, Restaurant—C, Grocery—C, and Ciearette Lice
Company Name: SuperAmerica Group Division of Ashland DBA: G»nPrAmP,-;ra dk449n
Business Addresss: 1125 7th St W Susiness Phone: zz1-1021
Contact NameJAddress: �ren Moore, 1125 7th St W, 102 Home Phone:
Date to Council Research: /
Public Hearing Date: �� Zg � labels Orderecl: G � Q NR
Notice Serrt to Appiiqrn: District Councii #: !
Notice Sent to Pubtic: ��/ �� ���� Ward #: �
Department/ Date Inspections Comments
City Attorney
�'•2 •9�- o, �
Environmental
Heaith
5 2•`"l� L�•�•
Fire
5•Z'�� �3� •
License Site Pian Received:
�a� t���ea:
S' �(t f..l �j �i
t� �1
Police
� � Z •q' �' �� � -
Zoning
�•2��� �'r` .
MAR-19-1997 11�68
612 266
CITSL.QE,_5T PAUL LIEP
CT..-ASS TII CITY OF SAINT PAU[.
o&« ofs:�:, i�p«s«s
, � ; LICENSE APPLICATI4N ����
30gP�u5t5�30D
� ♦ S�PCd SSiO3
� �yy�)�f� � �1 ���0 l����r1" � i" �� (��90967mcf�1669146
Tl�••q • •
TF�i APPLiC �7�S i�4'�'�I`F���3��� � �• �f '► 7�++�
PLFASE'fYPE ORPRINT IN II�: � T � v
Y�pe of License(s) bang aPPlied for:
.
Comgffiy Nawe:
Cocpontiou 1 Y+rtnasdip ! Solz Psoprietontip
If business is incorpaated, give date of incoigoration: ,
��x�,�,�: � e..�3 e Avk.r R� r�
��� aaa��: /! 2S l4,+P s�' '�-f� S�
so-ac wdd�aa crt5'
Betwan what cross suee.is is the busness located?
Are thc premises now ocr. ied7 Whac Type of Business?
� ro aaa��: _...p � g (I1G 1 V�U � 1..e 1� i N4't
�cntm�.. cm
Name m�d Tido:
s T!/f.4-
s b.� F. U D
r ;. • ,.. ^ �"Rl!I��J�
s� �
WviC12 side of dx StrfGt?
n... �
—•----__ _ _
Fvu � .'N'idmc (Maidm) Is+t Yuk
�
HOIDC A�LCSS: �� I.� vd! f� U O Q �
Sputt.d&cs Ciry SWc Zip
Aate of $irth: 1� ��S _(� Place of Binh: Home Pnonelaa 1. 3 S7 � Z 13
Ha�e you ever been comlcc� of aztg felony, aime or violadon ofany city ordinance other than traffic? YES � NO �_
Date of a�resc: Where7
Charge:
Coavictiau: 5entmcc:
List drnauxs andresidenoes of three petsoas of good moral chm�actcr, living wzthin the Twiu Cilies Metro Area, aot srlatcd to the applicant
or fiasnciall} interested in thepremises ar bwiness, who msy bc icfared to as to tiae appSicanYs charaeter:
AIt1ME _n ADDRESS PHONE
��t.Rd l� 10�t.1 S" 14 7� 0-daN D S'�S .�} ���- 11- y36-S.T3 �
_ !'�N�� '�� � �A14l���� ST N� " ����/1`��� b�� 633-�1-Yy
�
Have aus�'of the above named
���77��
� , � ., i
,:t`�:�� .� .�
V j�/ I
have an
YES � NO If ye; list tlu dse�s �ct �asons foz revocerion:
21t8�97
MAR-19-1357 11=08 CI7y nF „ST PA�- LIEP 612 266 9124 P.04i06
°�'�rb�l�
1.se cou Roin� :a oPezYlc this busiAess p�°n�'� YES �;3o Ff not, «'ho w9U op«ate ��fIPER AMERICAGROIJ�
p,Kr� go¢eg to �e a�tger or ess.�zat in this business? YES :�0 If th� msaager is na the same ts tbe apecator,
Pkzse listyour emp3o;ment kustory for the prc��o:zs five (5) c•eu period:
: /E lo�xn t Address
is e Parm4shiP, P]er,se iaclude jhe £olly��ing info:mavoa fac each parma (use additionat gages if necessary)�
xv.�eadd� saxc�e Cnr su�e Zia x,o��SmsQ
Fcs.\mc ?Sid9ctoi6d (-�3u&a) Laa Datcef$atb
lioxRddrac Scea!wmo Ccy Sute Zip Phox;.'umba
MIt�TAES07A TAX IDENI7FiCt+1'ION NUMBER - P�t w the Isws of �ota,1984, Chapta 502, Article 8, Sxtion 2(270.72?
(Tae Cieermce, Issusaee ofLicw,es).liaasing suthorities are req�ed to provide to tbe State of Mmnesota Cammissioner of Revenu�, the
NGunaota bzuiaess tax idmtifica2ion wmba aad thc social securiry armmber of cach licaue appHcant
Uuder tfie M�aaesota Govamneat Data Praci'sces Aa �si she F�dar1 Pricacy Act of t 974, we sre required to ad�ise you of the follaa�ing
regard'mg the use ofthe 2vlumesota Tsc Ideottificafion Numba:
- I3is infamatia� msy be e�sed to dez� tLe issvana or reaewal of yrnu fianse in the eveat you owe Mumcsota sa]es, empIoyei s
wrthhole3vig a mot�'vdricle exase t�ce�
' UP°a r�vm8 4ds info�mseoa. tFie Gcemia8 �ry ��PPig it oalp W tfie �a LkParment of Fteveaue. Howe�er,
unda the Fedaet ExcLmzge of Infocatatioa A�� the Dq>�tment of Rcveaue maS su�FlS this int"ormslian w the rnteraa3
Reveaue Savice. - -
Mmar�ta SaxIdmUScffiic�Numbe:s (Swlcs &TJse Tax Nuwba�)may Ix o� &om tbe State of Nf�nncsote, Business Rxc.or3s Dep�tment.
70RivrrParkPlazs(612-2%-618!} .. _ ..... _.
s��t s��yr�a�:.��3 ,! a-a-�S G �� r�ia�ns�u�rr��: -!� �:� ��
! lf a I�fanesota Ta�c ]drntificarioa 1+7nmbc is not regu:ued for tLe businas being operated, indicato so by placing an'X" ia �e box
..,, e �,-,
Lis� zll other o�eers af the c�po: eGon:
p�� TT� $p?vIF� HOVi£ BUSL�'ESS DATEOF
:..r+.�. tO�aaHe}d) � ADI}RESS PHO�'E PHOIv'E BIRTH