97-649counail File $ �`0��1
Ordinance #
creen sheet # -35
RESOU7TION
CITY OF SAINT PAUL, MINNESOTA �'1
Presented By
Referred To
Committee: Date
1 RES4LVED: That application (ID #99769) for a Gas Station, Restaurant-C, C3roceay-C, and Cigazette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4358 (Hetb I.entsch, Manager) at
3 756 Snelling Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays sen
7 Bae�ky
8 Bostrom � —�� pff;ce o£ Licenae Insoections and
9 Harris
10 M r Environmental Protection
12 Thun � �
13 Morton —� /�
� Jc ��
15 ' n°� Bp: \�1�10�
16 Adopted by Council: Date 'v \ a
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 �('� /
21 By:��� ` d {-��r----"-`. �p � �
22 $Y� `1 /UrQ � ceXvuo�.
23 Approved by Mayor: Date � U
24 �
25 Approved by Mayor for Submission to
z6 $y. � Council
27
By:
�t"l--bYS
DEPAA7MENT/OFFICE/CAUNCIL DATEINITIATED GREEN SHEE �O 35322
LIEP/Licensin - - --
CONTACf PERSON 8 PHONE � DEP/1RfMEMDIRECfOR � CITV CqUNCIL �NRIAVDATE
Christine Rozek, 266-9108 "�'�" �cmnrronNer �CRYCLERK
NUYBERFOR
MUST BE ON CAUNCIL AGENDA BY (DA'f� pp�NG a BUWET DIRECfOR Q PIN. & MGT. SERVICES DIR.
r'OI hearin : `z$� �I ONOER �Mpypq�OFAS5ISTAN'f� O
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
ACiK1N RE�UESScD:
The SugerAmerica Group Division.of Ashland DBA Super9merica �4358 requests Council approval
o£ its application for a Gas Station,�Restaurant=C, Grocery-C, and Cigarette License located
at 756 Snelling Aveaue North (ID 99769).
RECOMMENDATIONS: Appro�e (A) or Reject (R) pERSONAL SEHVICE CONTflACTS MUST ANSWER 7XE POLLOWIN6 QUESTIONS:
__ PIANNtNG COMM4SSI�N _ CIYIL SERVICE CAMMISSION �� Has this perso�rm ever worketl under a coMract for this department? -
_ Cre CoMMtT7EE _ YES NO
2. Has Mis person/firm ever been a ciry employee?
_ SiAFF _ YES NO
_ DIS7AICT COUR7 _ 3. Does this person�rm possess a 51ti11 not normall
y possessed by any curreM city employee?
SUPPoflTS WHICH CAUNCIL OBJECTIVE? YES NO
Explafn all yes answers on separate sheet and atteeh to green sheet
INITIATING PROBLEM, ISSUE, OPPtIRTUNRV (Who, What, When, Where, Why):
ADVANTAGESIFAPPROVED:
OlSAOVANTAGES IF APPROVEO:
� „P� r �p,�;i r'....�.,.. �'A:�*y,�yp
4�Sw�-u. . �;u Y,T�!'.369T�
fik�t�`'I' �. � l���
DISADVANTAGESIFNDTAPPROVED: _ ----_•-
TOTAL AMOUNT OF TRANSACt10N S COSTfREYENUE BUDGE7ED (CIRCLE ONE) YES NO
FUNDING SOUHCE ACTIVITV NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensheei # 35322 L.I.E.P. REVIEW CHECKLIST
In TrackeR
Date: 3/27l97 /
APP'n Recaived / APP'n Processed
�� ���
Lic2nselD# 44769 LiCertseType:Gas Station, Restaurant-C. Grocerv-C. and�garerte .�cei
COttlp3�y Name: SuperAmerica Group Division of Ashland DBA: �,ne m � a�E4 58
BUSirtess Addresss: �56 Snelling Avenue North BUSiness Phone: 646-4104
Contact NameJAddress: Snelling Avenue N, 55104 Home Phone:
Herb Lentsch
Date to Councq Research: r
Public Hearing Date: 2 labels Ordered: nJ�
Notice Sent to Apqlicant:_ ___.� C ___ District Councii #: ��
Notice Sent to Public:_�
Department/
City Attorney
7
Date Inspections
'
Environmental
Health
.,,_
!�/dG �
^ Ward #:
Comments
�' d . 1'� •
� • 'N•
Fire
License
5 ��� �
Police
�G
Zoning
� �Ci
�7-�
Site Pian Receivad:_
Lease Reaeived:
�
MRR-19-1997 11�08
iV M/ —
C�.ASS II[ CTTY OF SAINT PAL7L.
LICENSE APPLICATION �"� �
� 1 �ar ' �,��`�.�`�
� �� ��
��FODt a0 �K1�3. �° � 4�3.z j t��M.
lhv+�lYtL�t � r� f , 5 r
s .a�r c • �{"¢'�1, �, �fs�,Sl
PLEASE TYPE OR PR1NT IN 1NK �
� aPP&ed for:
,
Compffig Name:
If bvsiness is inco�orated, give date of incorporation: _
�� s�;� �: �, eArk.c Ri u�
��� aaar�:7 sL, it�'G�- �,et/.:
Strat Addrat '� City
BCtR'Gen Wh81 Cro5s sheeis 75 thc busiuess IocfltCd?
An the prer�ises aow occupied? What Type of Bus'xaess?
Ms;1 ro wa3ress: ,.� d,,�� 1�,(C��1 � LC> 1C / N(�'�'
Sk� add�a�n Go
CITY OF ST PAUL �IFP
�
G --
Nsme snd Title:
F'vn
'.�fidAe
G�idc+)
Ho� Address:
in:
Strat A�m City Swe Zsp
Z7ate of Birth: f ��. S/ ..1�,� Place of Bittlt: Home Phane:La b 3 Sy 1� 1,$
Haveyov ever bcen wmicud of arry fcFaray, a'ime qrvjoJation of airyciry o:dinance otherth.m ira�cl YE3 NO �_
Date of azrest: Wfiere?
C&arge:
Coaviction: Seuta�ce:
List dr nama andtzsidences of tt¢ce persons of go�d moral charac[a, &ving within the Twin Cities Metro Area, not rriatcd ta the apglicant
or fiaancia2ly interasted ia the premises or business, who may ix r�'cred ta as to the appIicaat's chatscfer.
NAME ADDRESS PHONE
��1�d I1�oRAt,► S- iY �2 0-yaN D S7'S .��i�- �1�-�13L-S337
Have �'of the aboVe namtd
1101 %.taivC � i.".
� . ♦ �'"L' i
.,.�.. � . .�:
�.,� ._ a
��
612 266 9124 P.
t�! p S!'L
Statc Tip
t ��
� r�
`wl_-Iw t��,
YES � NO ffyes, list she deus md reasons for revocnrion:
S
S
S
S
S
�'�v �-F As1,�kNd ��
36
� BusiaessPhone: �y `�i 7+�'��4�
T V'A � M N
State Zep
w�� ua� �ts� �r.
2/18�97
MAR-19-1997 11�08 CIT1' OF ST PAUL LIEP 612 266 9124 P.04/06
'"'� �1 ���1
Are }vu going ,o operzu ihis bvsiaess pasoas2l)'? YES � NO Ff not, �rho wiU optrxte AMERICAG�OiIP
r��
r�.u�,: 5a�a.�� �r •
Aiecv.��w,ta�zcra�geroress,Szacinthisbusiaess? YES
,,, , :.r•r.
Box 1
s� z;� ��,��
;30 If sl�e mmxger is not thc same �s tbe operator,
info;mation for each partaer <use addixioasl pages if aer.essffiyj:
(•ua�a�n> Ua
xc.�eAa3ro+� Svaz�cmc Car sWc Liv P�e:d.�ba
Fi-a\aae �ddfe5aitid �faibeal LaA DewefBirth
FivseAddrtu' Suca?cc¢e Cify Suu Tip Irnc�\5+m1xt
MA72�'ES07A TAX IDENI7FICATION NUA48IIt - P�t to thc Lz�rs of 2�ia�esota,1984, Chapta 502, Ariick 8, S�tioa 2(270•72)
{Tae Ci�reaa; L�suaaa of Licenses). &ccnsiag suthorities are re�uiral to provide w the State of Muwesota Cammissiener of Revcaeu. the
M'umaota busiaess tae identification aumba aad the social securiry a�ber of caek &eaue appfioent
Undei the Mwaesota CTwamneat Data Pracxias A�x �d t}ae Fedcal Pricacg Ad of t 474, we me required to ad�ise you of the follau�ing
regard'mg the use ofthe 2�irme.wta Tae Ide�ification Ntttnbex:
- 2his int'amati� msq be used to da� the;r� a renewet of yocs &cccse in th¢ evart you owe Mum�sots saies, employ�r s
a+ithho]dvig or mot� vebicle acase texs�
' UP°a secavm8 4ris znfo:mafioa. ttie liceusiag authasiry w�il supply it craty W tFte M�nuesota DeQazaneat af Revmue. However,
unda the Federal Exch�gc of Information Agreemeni, the Depmtrncnt of Revenue raa}' suPPIY tLis inf"omiatian W ihe Sntemai
Revwue Seivicc ' ,
r,r� r� r�«� � es� � u� r� rr,�� � t� a�a �� s,�ti �r �, a,� �a� ��,ew,
10 RivrrPark Plazx (622-29b-6I81} ... _ ... , .
s�� s«�� rn��: �� /— � ! �a-�S G _ �� r�x �a��u� x�t�: - /.� �Z� v�.$
_]f a M'sswesota Tax ]dcntificaton Nwuba is aot reguised for �e busincss being operated, indicato so by placing aa `X' ia ttx 6ox.
�„a�,>
Pkuc list your emplo;mem hinary for tfie prc�7ou five (5}; az� period:
List a11 otber o�cecs of ttse coipo;ztion:
pFFtCEIt T1T�E HO?✓�E H0� $USL'v'ESS 3JATE OF
�,*de,�t� _ (O�'ictHeLi) . ADARESS PHO\'E PHOA� BIRTH
counail File $ �`0��1
Ordinance #
creen sheet # -35
RESOU7TION
CITY OF SAINT PAUL, MINNESOTA �'1
Presented By
Referred To
Committee: Date
1 RES4LVED: That application (ID #99769) for a Gas Station, Restaurant-C, C3roceay-C, and Cigazette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4358 (Hetb I.entsch, Manager) at
3 756 Snelling Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays sen
7 Bae�ky
8 Bostrom � —�� pff;ce o£ Licenae Insoections and
9 Harris
10 M r Environmental Protection
12 Thun � �
13 Morton —� /�
� Jc ��
15 ' n°� Bp: \�1�10�
16 Adopted by Council: Date 'v \ a
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 �('� /
21 By:��� ` d {-��r----"-`. �p � �
22 $Y� `1 /UrQ � ceXvuo�.
23 Approved by Mayor: Date � U
24 �
25 Approved by Mayor for Submission to
z6 $y. � Council
27
By:
�t"l--bYS
DEPAA7MENT/OFFICE/CAUNCIL DATEINITIATED GREEN SHEE �O 35322
LIEP/Licensin - - --
CONTACf PERSON 8 PHONE � DEP/1RfMEMDIRECfOR � CITV CqUNCIL �NRIAVDATE
Christine Rozek, 266-9108 "�'�" �cmnrronNer �CRYCLERK
NUYBERFOR
MUST BE ON CAUNCIL AGENDA BY (DA'f� pp�NG a BUWET DIRECfOR Q PIN. & MGT. SERVICES DIR.
r'OI hearin : `z$� �I ONOER �Mpypq�OFAS5ISTAN'f� O
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
ACiK1N RE�UESScD:
The SugerAmerica Group Division.of Ashland DBA Super9merica �4358 requests Council approval
o£ its application for a Gas Station,�Restaurant=C, Grocery-C, and Cigarette License located
at 756 Snelling Aveaue North (ID 99769).
RECOMMENDATIONS: Appro�e (A) or Reject (R) pERSONAL SEHVICE CONTflACTS MUST ANSWER 7XE POLLOWIN6 QUESTIONS:
__ PIANNtNG COMM4SSI�N _ CIYIL SERVICE CAMMISSION �� Has this perso�rm ever worketl under a coMract for this department? -
_ Cre CoMMtT7EE _ YES NO
2. Has Mis person/firm ever been a ciry employee?
_ SiAFF _ YES NO
_ DIS7AICT COUR7 _ 3. Does this person�rm possess a 51ti11 not normall
y possessed by any curreM city employee?
SUPPoflTS WHICH CAUNCIL OBJECTIVE? YES NO
Explafn all yes answers on separate sheet and atteeh to green sheet
INITIATING PROBLEM, ISSUE, OPPtIRTUNRV (Who, What, When, Where, Why):
ADVANTAGESIFAPPROVED:
OlSAOVANTAGES IF APPROVEO:
� „P� r �p,�;i r'....�.,.. �'A:�*y,�yp
4�Sw�-u. . �;u Y,T�!'.369T�
fik�t�`'I' �. � l���
DISADVANTAGESIFNDTAPPROVED: _ ----_•-
TOTAL AMOUNT OF TRANSACt10N S COSTfREYENUE BUDGE7ED (CIRCLE ONE) YES NO
FUNDING SOUHCE ACTIVITV NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensheei # 35322 L.I.E.P. REVIEW CHECKLIST
In TrackeR
Date: 3/27l97 /
APP'n Recaived / APP'n Processed
�� ���
Lic2nselD# 44769 LiCertseType:Gas Station, Restaurant-C. Grocerv-C. and�garerte .�cei
COttlp3�y Name: SuperAmerica Group Division of Ashland DBA: �,ne m � a�E4 58
BUSirtess Addresss: �56 Snelling Avenue North BUSiness Phone: 646-4104
Contact NameJAddress: Snelling Avenue N, 55104 Home Phone:
Herb Lentsch
Date to Councq Research: r
Public Hearing Date: 2 labels Ordered: nJ�
Notice Sent to Apqlicant:_ ___.� C ___ District Councii #: ��
Notice Sent to Public:_�
Department/
City Attorney
7
Date Inspections
'
Environmental
Health
.,,_
!�/dG �
^ Ward #:
Comments
�' d . 1'� •
� • 'N•
Fire
License
5 ��� �
Police
�G
Zoning
� �Ci
�7-�
Site Pian Receivad:_
Lease Reaeived:
�
MRR-19-1997 11�08
iV M/ —
C�.ASS II[ CTTY OF SAINT PAL7L.
LICENSE APPLICATION �"� �
� 1 �ar ' �,��`�.�`�
� �� ��
��FODt a0 �K1�3. �° � 4�3.z j t��M.
lhv+�lYtL�t � r� f , 5 r
s .a�r c • �{"¢'�1, �, �fs�,Sl
PLEASE TYPE OR PR1NT IN 1NK �
� aPP&ed for:
,
Compffig Name:
If bvsiness is inco�orated, give date of incorporation: _
�� s�;� �: �, eArk.c Ri u�
��� aaar�:7 sL, it�'G�- �,et/.:
Strat Addrat '� City
BCtR'Gen Wh81 Cro5s sheeis 75 thc busiuess IocfltCd?
An the prer�ises aow occupied? What Type of Bus'xaess?
Ms;1 ro wa3ress: ,.� d,,�� 1�,(C��1 � LC> 1C / N(�'�'
Sk� add�a�n Go
CITY OF ST PAUL �IFP
�
G --
Nsme snd Title:
F'vn
'.�fidAe
G�idc+)
Ho� Address:
in:
Strat A�m City Swe Zsp
Z7ate of Birth: f ��. S/ ..1�,� Place of Bittlt: Home Phane:La b 3 Sy 1� 1,$
Haveyov ever bcen wmicud of arry fcFaray, a'ime qrvjoJation of airyciry o:dinance otherth.m ira�cl YE3 NO �_
Date of azrest: Wfiere?
C&arge:
Coaviction: Seuta�ce:
List dr nama andtzsidences of tt¢ce persons of go�d moral charac[a, &ving within the Twin Cities Metro Area, not rriatcd ta the apglicant
or fiaancia2ly interasted ia the premises or business, who may ix r�'cred ta as to the appIicaat's chatscfer.
NAME ADDRESS PHONE
��1�d I1�oRAt,► S- iY �2 0-yaN D S7'S .��i�- �1�-�13L-S337
Have �'of the aboVe namtd
1101 %.taivC � i.".
� . ♦ �'"L' i
.,.�.. � . .�:
�.,� ._ a
��
612 266 9124 P.
t�! p S!'L
Statc Tip
t ��
� r�
`wl_-Iw t��,
YES � NO ffyes, list she deus md reasons for revocnrion:
S
S
S
S
S
�'�v �-F As1,�kNd ��
36
� BusiaessPhone: �y `�i 7+�'��4�
T V'A � M N
State Zep
w�� ua� �ts� �r.
2/18�97
MAR-19-1997 11�08 CIT1' OF ST PAUL LIEP 612 266 9124 P.04/06
'"'� �1 ���1
Are }vu going ,o operzu ihis bvsiaess pasoas2l)'? YES � NO Ff not, �rho wiU optrxte AMERICAG�OiIP
r��
r�.u�,: 5a�a.�� �r •
Aiecv.��w,ta�zcra�geroress,Szacinthisbusiaess? YES
,,, , :.r•r.
Box 1
s� z;� ��,��
;30 If sl�e mmxger is not thc same �s tbe operator,
info;mation for each partaer <use addixioasl pages if aer.essffiyj:
(•ua�a�n> Ua
xc.�eAa3ro+� Svaz�cmc Car sWc Liv P�e:d.�ba
Fi-a\aae �ddfe5aitid �faibeal LaA DewefBirth
FivseAddrtu' Suca?cc¢e Cify Suu Tip Irnc�\5+m1xt
MA72�'ES07A TAX IDENI7FICATION NUA48IIt - P�t to thc Lz�rs of 2�ia�esota,1984, Chapta 502, Ariick 8, S�tioa 2(270•72)
{Tae Ci�reaa; L�suaaa of Licenses). &ccnsiag suthorities are re�uiral to provide w the State of Muwesota Cammissiener of Revcaeu. the
M'umaota busiaess tae identification aumba aad the social securiry a�ber of caek &eaue appfioent
Undei the Mwaesota CTwamneat Data Pracxias A�x �d t}ae Fedcal Pricacg Ad of t 474, we me required to ad�ise you of the follau�ing
regard'mg the use ofthe 2�irme.wta Tae Ide�ification Ntttnbex:
- 2his int'amati� msq be used to da� the;r� a renewet of yocs &cccse in th¢ evart you owe Mum�sots saies, employ�r s
a+ithho]dvig or mot� vebicle acase texs�
' UP°a secavm8 4ris znfo:mafioa. ttie liceusiag authasiry w�il supply it craty W tFte M�nuesota DeQazaneat af Revmue. However,
unda the Federal Exch�gc of Information Agreemeni, the Depmtrncnt of Revenue raa}' suPPIY tLis inf"omiatian W ihe Sntemai
Revwue Seivicc ' ,
r,r� r� r�«� � es� � u� r� rr,�� � t� a�a �� s,�ti �r �, a,� �a� ��,ew,
10 RivrrPark Plazx (622-29b-6I81} ... _ ... , .
s�� s«�� rn��: �� /— � ! �a-�S G _ �� r�x �a��u� x�t�: - /.� �Z� v�.$
_]f a M'sswesota Tax ]dcntificaton Nwuba is aot reguised for �e busincss being operated, indicato so by placing aa `X' ia ttx 6ox.
�„a�,>
Pkuc list your emplo;mem hinary for tfie prc�7ou five (5}; az� period:
List a11 otber o�cecs of ttse coipo;ztion:
pFFtCEIt T1T�E HO?✓�E H0� $USL'v'ESS 3JATE OF
�,*de,�t� _ (O�'ictHeLi) . ADARESS PHO\'E PHOA� BIRTH
counail File $ �`0��1
Ordinance #
creen sheet # -35
RESOU7TION
CITY OF SAINT PAUL, MINNESOTA �'1
Presented By
Referred To
Committee: Date
1 RES4LVED: That application (ID #99769) for a Gas Station, Restaurant-C, C3roceay-C, and Cigazette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4358 (Hetb I.entsch, Manager) at
3 756 Snelling Avenue be and the same is hereby approved.
4
5 Requested by Department of:
6 Yeas Nays sen
7 Bae�ky
8 Bostrom � —�� pff;ce o£ Licenae Insoections and
9 Harris
10 M r Environmental Protection
12 Thun � �
13 Morton —� /�
� Jc ��
15 ' n°� Bp: \�1�10�
16 Adopted by Council: Date 'v \ a
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20 �('� /
21 By:��� ` d {-��r----"-`. �p � �
22 $Y� `1 /UrQ � ceXvuo�.
23 Approved by Mayor: Date � U
24 �
25 Approved by Mayor for Submission to
z6 $y. � Council
27
By:
�t"l--bYS
DEPAA7MENT/OFFICE/CAUNCIL DATEINITIATED GREEN SHEE �O 35322
LIEP/Licensin - - --
CONTACf PERSON 8 PHONE � DEP/1RfMEMDIRECfOR � CITV CqUNCIL �NRIAVDATE
Christine Rozek, 266-9108 "�'�" �cmnrronNer �CRYCLERK
NUYBERFOR
MUST BE ON CAUNCIL AGENDA BY (DA'f� pp�NG a BUWET DIRECfOR Q PIN. & MGT. SERVICES DIR.
r'OI hearin : `z$� �I ONOER �Mpypq�OFAS5ISTAN'f� O
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
ACiK1N RE�UESScD:
The SugerAmerica Group Division.of Ashland DBA Super9merica �4358 requests Council approval
o£ its application for a Gas Station,�Restaurant=C, Grocery-C, and Cigarette License located
at 756 Snelling Aveaue North (ID 99769).
RECOMMENDATIONS: Appro�e (A) or Reject (R) pERSONAL SEHVICE CONTflACTS MUST ANSWER 7XE POLLOWIN6 QUESTIONS:
__ PIANNtNG COMM4SSI�N _ CIYIL SERVICE CAMMISSION �� Has this perso�rm ever worketl under a coMract for this department? -
_ Cre CoMMtT7EE _ YES NO
2. Has Mis person/firm ever been a ciry employee?
_ SiAFF _ YES NO
_ DIS7AICT COUR7 _ 3. Does this person�rm possess a 51ti11 not normall
y possessed by any curreM city employee?
SUPPoflTS WHICH CAUNCIL OBJECTIVE? YES NO
Explafn all yes answers on separate sheet and atteeh to green sheet
INITIATING PROBLEM, ISSUE, OPPtIRTUNRV (Who, What, When, Where, Why):
ADVANTAGESIFAPPROVED:
OlSAOVANTAGES IF APPROVEO:
� „P� r �p,�;i r'....�.,.. �'A:�*y,�yp
4�Sw�-u. . �;u Y,T�!'.369T�
fik�t�`'I' �. � l���
DISADVANTAGESIFNDTAPPROVED: _ ----_•-
TOTAL AMOUNT OF TRANSACt10N S COSTfREYENUE BUDGE7ED (CIRCLE ONE) YES NO
FUNDING SOUHCE ACTIVITV NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensheei # 35322 L.I.E.P. REVIEW CHECKLIST
In TrackeR
Date: 3/27l97 /
APP'n Recaived / APP'n Processed
�� ���
Lic2nselD# 44769 LiCertseType:Gas Station, Restaurant-C. Grocerv-C. and�garerte .�cei
COttlp3�y Name: SuperAmerica Group Division of Ashland DBA: �,ne m � a�E4 58
BUSirtess Addresss: �56 Snelling Avenue North BUSiness Phone: 646-4104
Contact NameJAddress: Snelling Avenue N, 55104 Home Phone:
Herb Lentsch
Date to Councq Research: r
Public Hearing Date: 2 labels Ordered: nJ�
Notice Sent to Apqlicant:_ ___.� C ___ District Councii #: ��
Notice Sent to Public:_�
Department/
City Attorney
7
Date Inspections
'
Environmental
Health
.,,_
!�/dG �
^ Ward #:
Comments
�' d . 1'� •
� • 'N•
Fire
License
5 ��� �
Police
�G
Zoning
� �Ci
�7-�
Site Pian Receivad:_
Lease Reaeived:
�
MRR-19-1997 11�08
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C�.ASS II[ CTTY OF SAINT PAL7L.
LICENSE APPLICATION �"� �
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PLEASE TYPE OR PR1NT IN 1NK �
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Compffig Name:
If bvsiness is inco�orated, give date of incorporation: _
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Strat Addrat '� City
BCtR'Gen Wh81 Cro5s sheeis 75 thc busiuess IocfltCd?
An the prer�ises aow occupied? What Type of Bus'xaess?
Ms;1 ro wa3ress: ,.� d,,�� 1�,(C��1 � LC> 1C / N(�'�'
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CITY OF ST PAUL �IFP
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Z7ate of Birth: f ��. S/ ..1�,� Place of Bittlt: Home Phane:La b 3 Sy 1� 1,$
Haveyov ever bcen wmicud of arry fcFaray, a'ime qrvjoJation of airyciry o:dinance otherth.m ira�cl YE3 NO �_
Date of azrest: Wfiere?
C&arge:
Coaviction: Seuta�ce:
List dr nama andtzsidences of tt¢ce persons of go�d moral charac[a, &ving within the Twin Cities Metro Area, not rriatcd ta the apglicant
or fiaancia2ly interasted ia the premises or business, who may ix r�'cred ta as to the appIicaat's chatscfer.
NAME ADDRESS PHONE
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Have �'of the aboVe namtd
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YES � NO ffyes, list she deus md reasons for revocnrion:
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MAR-19-1997 11�08 CIT1' OF ST PAUL LIEP 612 266 9124 P.04/06
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Are }vu going ,o operzu ihis bvsiaess pasoas2l)'? YES � NO Ff not, �rho wiU optrxte AMERICAG�OiIP
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Aiecv.��w,ta�zcra�geroress,Szacinthisbusiaess? YES
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Box 1
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;30 If sl�e mmxger is not thc same �s tbe operator,
info;mation for each partaer <use addixioasl pages if aer.essffiyj:
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Fi-a\aae �ddfe5aitid �faibeal LaA DewefBirth
FivseAddrtu' Suca?cc¢e Cify Suu Tip Irnc�\5+m1xt
MA72�'ES07A TAX IDENI7FICATION NUA48IIt - P�t to thc Lz�rs of 2�ia�esota,1984, Chapta 502, Ariick 8, S�tioa 2(270•72)
{Tae Ci�reaa; L�suaaa of Licenses). &ccnsiag suthorities are re�uiral to provide w the State of Muwesota Cammissiener of Revcaeu. the
M'umaota busiaess tae identification aumba aad the social securiry a�ber of caek &eaue appfioent
Undei the Mwaesota CTwamneat Data Pracxias A�x �d t}ae Fedcal Pricacg Ad of t 474, we me required to ad�ise you of the follau�ing
regard'mg the use ofthe 2�irme.wta Tae Ide�ification Ntttnbex:
- 2his int'amati� msq be used to da� the;r� a renewet of yocs &cccse in th¢ evart you owe Mum�sots saies, employ�r s
a+ithho]dvig or mot� vebicle acase texs�
' UP°a secavm8 4ris znfo:mafioa. ttie liceusiag authasiry w�il supply it craty W tFte M�nuesota DeQazaneat af Revmue. However,
unda the Federal Exch�gc of Information Agreemeni, the Depmtrncnt of Revenue raa}' suPPIY tLis inf"omiatian W ihe Sntemai
Revwue Seivicc ' ,
r,r� r� r�«� � es� � u� r� rr,�� � t� a�a �� s,�ti �r �, a,� �a� ��,ew,
10 RivrrPark Plazx (622-29b-6I81} ... _ ... , .
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_]f a M'sswesota Tax ]dcntificaton Nwuba is aot reguised for �e busincss being operated, indicato so by placing aa `X' ia ttx 6ox.
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Pkuc list your emplo;mem hinary for tfie prc�7ou five (5}; az� period:
List a11 otber o�cecs of ttse coipo;ztion:
pFFtCEIt T1T�E HO?✓�E H0� $USL'v'ESS 3JATE OF
�,*de,�t� _ (O�'ictHeLi) . ADARESS PHO\'E PHOA� BIRTH