97-650Council File # ����
Ordinance #
Green Sheet # �✓ ` � �
Presented By
Referred To
1 RESOLVED: That application (ID #35944) for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4421 (Todd Perrigo, Manager) at
3 970 University Avenue West be and the same is hereby approved
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a�Tcey ��
8 Bostr_�m Office of License Insggqtions and
9 Harrzs �
10 Me a� —� Environmenta� Protection
11 �
12 Thune �
13 Morton
15 S � ` �
16 Adopted by Council: Date B Y' —
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20
21 By:
22 t By: fi /'L�_
23 Approved by Mayor: Date �'� 1�
24 �
25 Approved by Mayor for Submission to
26 $y. Council
27
By:
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA �
u���
�EPARTMENT/OFFICE/COUNCIL DAiE MITIATED GREEN SHEE �O 3 5 31� 9
LIEPJLicensin -- --
CANTACf PERSON & PHONE INITIAL/DATE INRIAVDATE
O �EPAPTMENT DIPECfOA � CRY GOUNCIL
Christine Rozek 266-9108 ^���" �cmarror+Ner �crrrc�r+K
MUST BE ON COUNGIL AGENDA BY (DA'IE) p��� � BUW E! DIRECiOfl � FlN. & MGT. SERVICES DIR.
S ONDER � MAVOFi (OR ASSISTANT� O
For hearin :
T07AL # OP SIGNATURE PAGES (CLIP ALl LOCATIONS FOR SIGNATUR�
ACTION REQUESTED:
The SuperAmerica Group Division of_Ashland DBA SuperAmerica 1�4421 requests Council approval
of its application for a Gas Station, Restaurant=C, Grocery-C, and Cigarette License located
at 97Q University Avenue West (ID #35944).
RECOtAeaENDnnoNS: nqxove (n) aRa�ect ip) PERSONAL SERVICE CONTRACTS MUSTANSWER TNE FOLLOWING QUEST/ONS:
_ PLPNNING C�MIAISSI�N _ CIV4l SERVICE COMMISSION 1. Has Nis person/firm ever worked under a contract for this departmeM? ,
, ��B CO�tMrtiEE _ YES NO
—�� — 2. Has this permnflirm ever bea� a city empbyee?
YES NO
_ OIS7RICT COURT _ 3. Does fhis personttirm passess a skill not normaN
Y P��sed by any curre�rt cRy amployee?
SUPPORS$ VJFIICH CAUNCIL O&IECSIVE? YES NO
Expfaln alt yes answers on separete sheet anA attech to groen sheet
1NITIATING PROBLEM, ISSUE. OPPOR7UNfTY (Who. W1iat When, Where. Wh»:
MAY 12 1997
J���Y ��.A!(EY
ADVANTAGESIFAPPROVED:
DISADVANTAGES IF APPROYED:
�6iia'�.^',.�$sf� �"� »�...�°f�^w� �^.Kyq'��yay
�:';Lt`i �� ia�l
DISADVANTAGES IF NOTAPPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/FiEVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE AC7IVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35319 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 /`i�b�
In Trackef? app'n aeceNed / npp'n arocessea
License ID # 35944 License Type: Gas Station, Restaurant—C, Grocerv—C, and Cigarette Lice�
Company Name:SuperAmerica Group Division of Ashland DBA: SuperAmerica f/4421
Business Addresss: 970 Universitv Avenue West BUSiness Phone: 646-4689
Contact Name/Address: Todd Perrigo, 970 University Ave W Home Phone:
Date to Council Research: 55104
Public Hearing Date: � Labels Ordered: /�' �
Notice Sent to Applicant: � District Council #: 8
.A i. /n
/ � ��
/
Notice Sent to Public: ! ` 0 � Ward #: �
Department/ Date Inspections Comments
C'dy Attorney
�l� o � .
Environmental
Health
N. �..
��
� q �- �".
Fire
5 �l� �j' � o ,
License Site Plan Received:_
Lease Received:
��g��t? DlG
Police
5" b � . � .
Zoning
� l� �l �- D . � •
MAR-19-1997 11�06 G�'f-9� ST PAUL LIEP
hold. famaly hcld. or may have an intetest in:
_ . _ °t�' ��
�� � CI"fY OF SAINT PAUT.
offi« o£timae, 7�ims
LICENSE APPLICATION ��� �°�
330SPe¢SLS�3�7
y�pcd�]6pq�rm SS@
� 2 2 (su'ixsssoso �isuJnsntze
RAl1ll, + 11 " I / - f . ! I ''
1 " r � � � ,�� .
� � -
'..� �� t ` � - Jx_ f
):t _ ,: !li�� b 9:�i J � - s � k - I
�• • f 1
T�pe ofLicense(s) beiag applied for:
Compsny Name:
.,,« - . .
If business is incorposated, 8ive date of incoiporation: � G "' o � �_
�� a�,�.�: � c; A1�.1 R i crA '�k 5��1i�
��� Aaar�: �� �.AN� �� J2:ti fa Qv.� ST�s}ra, l
� � `S ��
Betwan what cnoss s�Ceets is the business located?
Ar� th� ptesnises now oceupied? What Type of B�ess?
h,s;,To.��: P 0 B U�G t VUU �C L.e x i N�t c.�
skmc Add�w �
x�ffiar��_
612 266 9124, P.
�
� T N l �q, �It �vo� `�- N—
BusinessPhonr. �i(�. L �/4 — �lb�y
�,vs,l'i�/�1
s� �
wluch siae of the sa�eec�
pS/2
h°r. Zm
f,�.S f, A,�,��F�-
�y Tit3e
Home Addiess: � ° _
Sttat P.ddre+s
City � �
Date of Birth: ,ll.,� �I ��R.a Place of $irth:
Home Phone f. 3 S7 :] Z 1
Have yov ever been comicted of auy felony, aime or �iolation of any ciry ordinance other than tra�cl YES _ NO �_
Dzte of arcest: �`'��
��8�
Coaviction: S�ntwa:
I,ist the names and �esi� of ttvce persons of gaod moral chs�e�°�, li�'�S �'+� �e Twin Cities Metro Area, not rdated to the applicant
or fins�ially interested'm ihe premis..°s ar business, who may ix rcfarc:d to as to the agplicanYs char�ter:
ADDRESS PHONE
R s�a nneeAr.� S- 14 72 0-'laN 0 S7.'S •�1 ���- (nl�-`�3( �
Frrt
;vLdBc
(MaidcaJ
� I :�.f Ll
�
liceuses
Have �of the above nsmad
�_�1... i��.
��
i,Ewoked? YES � NO I£yes, list she dates avd reasons for revocadou:
2/18M?
MAR-19-1997 11�08 C,JS�BS ST PRLIL LIFP
612 266 9124 P,04 ��
Are }vu going ;o operpse tlsss busiaess �asonatl}•1 Y'ES �;�0 If aat, u$o wiU operzte �'�IPERAAiERICA G7�4i113
F;ra� �vcm��wu c�rrao� � P.O. Sox 1400�
Lexinqton KY qa5t
H�e�dbm. so-ea:�ae c;,• sn�e
�''i PhOne>>IDber
Art��gom3to�zctiau�aczgeroiessSsatinihisbtLSiaess? YES
plezsc coaplete the fdlrnc�g ixu`oimaiion:
� i . �/ ) .
�/ d
;30 If t�c maaager is not the sec�e Fs the operator,
Pkase list your emp3o;meas 2sistory for tbe pretio:ss fi�e (5) cezrperiod:
Bti�ess�EmoIo�mrnt Address
Da1c
far each parmer (use adrlitionsl pages if necessffiy)_
(•Vdaiden) L.a - —_. _ Duc
HoaeAddron: So-ea>eme CttS Slelc Ysp Phonel5�&r
Fc�t�amc �SddleIcitid (�Lidea7 La DatcofHrttlx
Hocc.4dd�os: SaeG:i� Gty Siate Zip PhaaeA4+mbei
Mt32`ESO7A TAX IDENI3FICATION NUMBER - p�ssuaat to thc Lau•s of �ot� 1984, Chagter SQ2, Article 8, Sutioa 2(270.72}
(Ta� Cleerana;lssuaace of Licensesj, &cepsiag authorities ere sequired to prodsde to ihe State of 2�nnesota Cammissiona of Revmu� the
NGnxusotabusiaesstsx idrn�Scationrntmba aadthe sociai sxwirynvmberof cachliaau app&caat
Uuder tbe M�iaacsot� CmverRmmt Dats Praczias pa �d shc Federsi Frivacy Aci �} 97d, we are requir�d to advise you of the follou�ing
�S�S �e use oft6e Mmnaota Tax Identificatiou Numba:
- 2his infama4on may be used to det�y the ;K or reaewst of yo�u tzccnsc za th� evart you owe Mumesats sa7es, empIoy$ s
withhdd'¢ig � motor vefiick exdse taxes,
' UPon receivmg t�s iaf�tiaa,lFie licensia8 avth�itY m�i suAPlp it oaty W�e �a Aepazuawt of Rcvrnex. However,
under the Fedaal ExcLffiegc of fnformadoa A�ment the I�partmcm of Reveaue may su�Ply this iuformation w tlu IMcnal
RevenaeSeivice. ._.. -
�a Tax IdeaU5ca6� Nssmbcs (Sat�& Use TaxN�b�C) may bc obtsiaed from tbe S�ate ofMnaesota, Buswess Rticords Deg�tmesu.
}012ivaPark Plsza (622-2%-6181�
���,��: 1- U � c � ��,T��������:-1�9o?3�SS
_ ffa M:anesofa Tax Idrntifica6on Plumba ss not requized for sbe businas bcing operated. indicste so by ptacing aa `X' ia rke box
�., e �,
List zll otha oacers of the co�o: ztion:
OFFIC�R TITT,� HOM.E HO'v,� HUS�TESS DATE OF
:iA1.2� (O�cxHejd) t ADt�S5 PHO\'E PHOh� BIRTH
Council File # ����
Ordinance #
Green Sheet # �✓ ` � �
Presented By
Referred To
1 RESOLVED: That application (ID #35944) for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4421 (Todd Perrigo, Manager) at
3 970 University Avenue West be and the same is hereby approved
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a�Tcey ��
8 Bostr_�m Office of License Insggqtions and
9 Harrzs �
10 Me a� —� Environmenta� Protection
11 �
12 Thune �
13 Morton
15 S � ` �
16 Adopted by Council: Date B Y' —
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20
21 By:
22 t By: fi /'L�_
23 Approved by Mayor: Date �'� 1�
24 �
25 Approved by Mayor for Submission to
26 $y. Council
27
By:
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA �
u���
�EPARTMENT/OFFICE/COUNCIL DAiE MITIATED GREEN SHEE �O 3 5 31� 9
LIEPJLicensin -- --
CANTACf PERSON & PHONE INITIAL/DATE INRIAVDATE
O �EPAPTMENT DIPECfOA � CRY GOUNCIL
Christine Rozek 266-9108 ^���" �cmarror+Ner �crrrc�r+K
MUST BE ON COUNGIL AGENDA BY (DA'IE) p��� � BUW E! DIRECiOfl � FlN. & MGT. SERVICES DIR.
S ONDER � MAVOFi (OR ASSISTANT� O
For hearin :
T07AL # OP SIGNATURE PAGES (CLIP ALl LOCATIONS FOR SIGNATUR�
ACTION REQUESTED:
The SuperAmerica Group Division of_Ashland DBA SuperAmerica 1�4421 requests Council approval
of its application for a Gas Station, Restaurant=C, Grocery-C, and Cigarette License located
at 97Q University Avenue West (ID #35944).
RECOtAeaENDnnoNS: nqxove (n) aRa�ect ip) PERSONAL SERVICE CONTRACTS MUSTANSWER TNE FOLLOWING QUEST/ONS:
_ PLPNNING C�MIAISSI�N _ CIV4l SERVICE COMMISSION 1. Has Nis person/firm ever worked under a contract for this departmeM? ,
, ��B CO�tMrtiEE _ YES NO
—�� — 2. Has this permnflirm ever bea� a city empbyee?
YES NO
_ OIS7RICT COURT _ 3. Does fhis personttirm passess a skill not normaN
Y P��sed by any curre�rt cRy amployee?
SUPPORS$ VJFIICH CAUNCIL O&IECSIVE? YES NO
Expfaln alt yes answers on separete sheet anA attech to groen sheet
1NITIATING PROBLEM, ISSUE. OPPOR7UNfTY (Who. W1iat When, Where. Wh»:
MAY 12 1997
J���Y ��.A!(EY
ADVANTAGESIFAPPROVED:
DISADVANTAGES IF APPROYED:
�6iia'�.^',.�$sf� �"� »�...�°f�^w� �^.Kyq'��yay
�:';Lt`i �� ia�l
DISADVANTAGES IF NOTAPPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/FiEVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE AC7IVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35319 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 /`i�b�
In Trackef? app'n aeceNed / npp'n arocessea
License ID # 35944 License Type: Gas Station, Restaurant—C, Grocerv—C, and Cigarette Lice�
Company Name:SuperAmerica Group Division of Ashland DBA: SuperAmerica f/4421
Business Addresss: 970 Universitv Avenue West BUSiness Phone: 646-4689
Contact Name/Address: Todd Perrigo, 970 University Ave W Home Phone:
Date to Council Research: 55104
Public Hearing Date: � Labels Ordered: /�' �
Notice Sent to Applicant: � District Council #: 8
.A i. /n
/ � ��
/
Notice Sent to Public: ! ` 0 � Ward #: �
Department/ Date Inspections Comments
C'dy Attorney
�l� o � .
Environmental
Health
N. �..
��
� q �- �".
Fire
5 �l� �j' � o ,
License Site Plan Received:_
Lease Received:
��g��t? DlG
Police
5" b � . � .
Zoning
� l� �l �- D . � •
MAR-19-1997 11�06 G�'f-9� ST PAUL LIEP
hold. famaly hcld. or may have an intetest in:
_ . _ °t�' ��
�� � CI"fY OF SAINT PAUT.
offi« o£timae, 7�ims
LICENSE APPLICATION ��� �°�
330SPe¢SLS�3�7
y�pcd�]6pq�rm SS@
� 2 2 (su'ixsssoso �isuJnsntze
RAl1ll, + 11 " I / - f . ! I ''
1 " r � � � ,�� .
� � -
'..� �� t ` � - Jx_ f
):t _ ,: !li�� b 9:�i J � - s � k - I
�• • f 1
T�pe ofLicense(s) beiag applied for:
Compsny Name:
.,,« - . .
If business is incorposated, 8ive date of incoiporation: � G "' o � �_
�� a�,�.�: � c; A1�.1 R i crA '�k 5��1i�
��� Aaar�: �� �.AN� �� J2:ti fa Qv.� ST�s}ra, l
� � `S ��
Betwan what cnoss s�Ceets is the business located?
Ar� th� ptesnises now oceupied? What Type of B�ess?
h,s;,To.��: P 0 B U�G t VUU �C L.e x i N�t c.�
skmc Add�w �
x�ffiar��_
612 266 9124, P.
�
� T N l �q, �It �vo� `�- N—
BusinessPhonr. �i(�. L �/4 — �lb�y
�,vs,l'i�/�1
s� �
wluch siae of the sa�eec�
pS/2
h°r. Zm
f,�.S f, A,�,��F�-
�y Tit3e
Home Addiess: � ° _
Sttat P.ddre+s
City � �
Date of Birth: ,ll.,� �I ��R.a Place of $irth:
Home Phone f. 3 S7 :] Z 1
Have yov ever been comicted of auy felony, aime or �iolation of any ciry ordinance other than tra�cl YES _ NO �_
Dzte of arcest: �`'��
��8�
Coaviction: S�ntwa:
I,ist the names and �esi� of ttvce persons of gaod moral chs�e�°�, li�'�S �'+� �e Twin Cities Metro Area, not rdated to the applicant
or fins�ially interested'm ihe premis..°s ar business, who may ix rcfarc:d to as to the agplicanYs char�ter:
ADDRESS PHONE
R s�a nneeAr.� S- 14 72 0-'laN 0 S7.'S •�1 ���- (nl�-`�3( �
Frrt
;vLdBc
(MaidcaJ
� I :�.f Ll
�
liceuses
Have �of the above nsmad
�_�1... i��.
��
i,Ewoked? YES � NO I£yes, list she dates avd reasons for revocadou:
2/18M?
MAR-19-1997 11�08 C,JS�BS ST PRLIL LIFP
612 266 9124 P,04 ��
Are }vu going ;o operpse tlsss busiaess �asonatl}•1 Y'ES �;�0 If aat, u$o wiU operzte �'�IPERAAiERICA G7�4i113
F;ra� �vcm��wu c�rrao� � P.O. Sox 1400�
Lexinqton KY qa5t
H�e�dbm. so-ea:�ae c;,• sn�e
�''i PhOne>>IDber
Art��gom3to�zctiau�aczgeroiessSsatinihisbtLSiaess? YES
plezsc coaplete the fdlrnc�g ixu`oimaiion:
� i . �/ ) .
�/ d
;30 If t�c maaager is not the sec�e Fs the operator,
Pkase list your emp3o;meas 2sistory for tbe pretio:ss fi�e (5) cezrperiod:
Bti�ess�EmoIo�mrnt Address
Da1c
far each parmer (use adrlitionsl pages if necessffiy)_
(•Vdaiden) L.a - —_. _ Duc
HoaeAddron: So-ea>eme CttS Slelc Ysp Phonel5�&r
Fc�t�amc �SddleIcitid (�Lidea7 La DatcofHrttlx
Hocc.4dd�os: SaeG:i� Gty Siate Zip PhaaeA4+mbei
Mt32`ESO7A TAX IDENI3FICATION NUMBER - p�ssuaat to thc Lau•s of �ot� 1984, Chagter SQ2, Article 8, Sutioa 2(270.72}
(Ta� Cleerana;lssuaace of Licensesj, &cepsiag authorities ere sequired to prodsde to ihe State of 2�nnesota Cammissiona of Revmu� the
NGnxusotabusiaesstsx idrn�Scationrntmba aadthe sociai sxwirynvmberof cachliaau app&caat
Uuder tbe M�iaacsot� CmverRmmt Dats Praczias pa �d shc Federsi Frivacy Aci �} 97d, we are requir�d to advise you of the follou�ing
�S�S �e use oft6e Mmnaota Tax Identificatiou Numba:
- 2his infama4on may be used to det�y the ;K or reaewst of yo�u tzccnsc za th� evart you owe Mumesats sa7es, empIoy$ s
withhdd'¢ig � motor vefiick exdse taxes,
' UPon receivmg t�s iaf�tiaa,lFie licensia8 avth�itY m�i suAPlp it oaty W�e �a Aepazuawt of Rcvrnex. However,
under the Fedaal ExcLffiegc of fnformadoa A�ment the I�partmcm of Reveaue may su�Ply this iuformation w tlu IMcnal
RevenaeSeivice. ._.. -
�a Tax IdeaU5ca6� Nssmbcs (Sat�& Use TaxN�b�C) may bc obtsiaed from tbe S�ate ofMnaesota, Buswess Rticords Deg�tmesu.
}012ivaPark Plsza (622-2%-6181�
���,��: 1- U � c � ��,T��������:-1�9o?3�SS
_ ffa M:anesofa Tax Idrntifica6on Plumba ss not requized for sbe businas bcing operated. indicste so by ptacing aa `X' ia rke box
�., e �,
List zll otha oacers of the co�o: ztion:
OFFIC�R TITT,� HOM.E HO'v,� HUS�TESS DATE OF
:iA1.2� (O�cxHejd) t ADt�S5 PHO\'E PHOh� BIRTH
Council File # ����
Ordinance #
Green Sheet # �✓ ` � �
Presented By
Referred To
1 RESOLVED: That application (ID #35944) for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License by
2 Super America Group Division of Ashland DBA SuperAmerica #4421 (Todd Perrigo, Manager) at
3 970 University Avenue West be and the same is hereby approved
4
5 Requested by Department of:
6 Yeas Navs Abse
7 B a�Tcey ��
8 Bostr_�m Office of License Insggqtions and
9 Harrzs �
10 Me a� —� Environmenta� Protection
11 �
12 Thune �
13 Morton
15 S � ` �
16 Adopted by Council: Date B Y' —
17
18 Adoption Certified by Council Secretary
19 Form Approved by City Attorney
20
21 By:
22 t By: fi /'L�_
23 Approved by Mayor: Date �'� 1�
24 �
25 Approved by Mayor for Submission to
26 $y. Council
27
By:
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA �
u���
�EPARTMENT/OFFICE/COUNCIL DAiE MITIATED GREEN SHEE �O 3 5 31� 9
LIEPJLicensin -- --
CANTACf PERSON & PHONE INITIAL/DATE INRIAVDATE
O �EPAPTMENT DIPECfOA � CRY GOUNCIL
Christine Rozek 266-9108 ^���" �cmarror+Ner �crrrc�r+K
MUST BE ON COUNGIL AGENDA BY (DA'IE) p��� � BUW E! DIRECiOfl � FlN. & MGT. SERVICES DIR.
S ONDER � MAVOFi (OR ASSISTANT� O
For hearin :
T07AL # OP SIGNATURE PAGES (CLIP ALl LOCATIONS FOR SIGNATUR�
ACTION REQUESTED:
The SuperAmerica Group Division of_Ashland DBA SuperAmerica 1�4421 requests Council approval
of its application for a Gas Station, Restaurant=C, Grocery-C, and Cigarette License located
at 97Q University Avenue West (ID #35944).
RECOtAeaENDnnoNS: nqxove (n) aRa�ect ip) PERSONAL SERVICE CONTRACTS MUSTANSWER TNE FOLLOWING QUEST/ONS:
_ PLPNNING C�MIAISSI�N _ CIV4l SERVICE COMMISSION 1. Has Nis person/firm ever worked under a contract for this departmeM? ,
, ��B CO�tMrtiEE _ YES NO
—�� — 2. Has this permnflirm ever bea� a city empbyee?
YES NO
_ OIS7RICT COURT _ 3. Does fhis personttirm passess a skill not normaN
Y P��sed by any curre�rt cRy amployee?
SUPPORS$ VJFIICH CAUNCIL O&IECSIVE? YES NO
Expfaln alt yes answers on separete sheet anA attech to groen sheet
1NITIATING PROBLEM, ISSUE. OPPOR7UNfTY (Who. W1iat When, Where. Wh»:
MAY 12 1997
J���Y ��.A!(EY
ADVANTAGESIFAPPROVED:
DISADVANTAGES IF APPROYED:
�6iia'�.^',.�$sf� �"� »�...�°f�^w� �^.Kyq'��yay
�:';Lt`i �� ia�l
DISADVANTAGES IF NOTAPPROVED:
TOTAL AMOUNT OF TRANSACTION $ COST/FiEVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE AC7IVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensneet # 35319 L.I.E.P. REVIEW CHECKLIST Date: 3/27/97 /`i�b�
In Trackef? app'n aeceNed / npp'n arocessea
License ID # 35944 License Type: Gas Station, Restaurant—C, Grocerv—C, and Cigarette Lice�
Company Name:SuperAmerica Group Division of Ashland DBA: SuperAmerica f/4421
Business Addresss: 970 Universitv Avenue West BUSiness Phone: 646-4689
Contact Name/Address: Todd Perrigo, 970 University Ave W Home Phone:
Date to Council Research: 55104
Public Hearing Date: � Labels Ordered: /�' �
Notice Sent to Applicant: � District Council #: 8
.A i. /n
/ � ��
/
Notice Sent to Public: ! ` 0 � Ward #: �
Department/ Date Inspections Comments
C'dy Attorney
�l� o � .
Environmental
Health
N. �..
��
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Fire
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License Site Plan Received:_
Lease Received:
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Police
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Zoning
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MAR-19-1997 11�06 G�'f-9� ST PAUL LIEP
hold. famaly hcld. or may have an intetest in:
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�� � CI"fY OF SAINT PAUT.
offi« o£timae, 7�ims
LICENSE APPLICATION ��� �°�
330SPe¢SLS�3�7
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T�pe ofLicense(s) beiag applied for:
Compsny Name:
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If business is incorposated, 8ive date of incoiporation: � G "' o � �_
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��� Aaar�: �� �.AN� �� J2:ti fa Qv.� ST�s}ra, l
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Betwan what cnoss s�Ceets is the business located?
Ar� th� ptesnises now oceupied? What Type of B�ess?
h,s;,To.��: P 0 B U�G t VUU �C L.e x i N�t c.�
skmc Add�w �
x�ffiar��_
612 266 9124, P.
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BusinessPhonr. �i(�. L �/4 — �lb�y
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s� �
wluch siae of the sa�eec�
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f,�.S f, A,�,��F�-
�y Tit3e
Home Addiess: � ° _
Sttat P.ddre+s
City � �
Date of Birth: ,ll.,� �I ��R.a Place of $irth:
Home Phone f. 3 S7 :] Z 1
Have yov ever been comicted of auy felony, aime or �iolation of any ciry ordinance other than tra�cl YES _ NO �_
Dzte of arcest: �`'��
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Coaviction: S�ntwa:
I,ist the names and �esi� of ttvce persons of gaod moral chs�e�°�, li�'�S �'+� �e Twin Cities Metro Area, not rdated to the applicant
or fins�ially interested'm ihe premis..°s ar business, who may ix rcfarc:d to as to the agplicanYs char�ter:
ADDRESS PHONE
R s�a nneeAr.� S- 14 72 0-'laN 0 S7.'S •�1 ���- (nl�-`�3( �
Frrt
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(MaidcaJ
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Have �of the above nsmad
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i,Ewoked? YES � NO I£yes, list she dates avd reasons for revocadou:
2/18M?
MAR-19-1997 11�08 C,JS�BS ST PRLIL LIFP
612 266 9124 P,04 ��
Are }vu going ;o operpse tlsss busiaess �asonatl}•1 Y'ES �;�0 If aat, u$o wiU operzte �'�IPERAAiERICA G7�4i113
F;ra� �vcm��wu c�rrao� � P.O. Sox 1400�
Lexinqton KY qa5t
H�e�dbm. so-ea:�ae c;,• sn�e
�''i PhOne>>IDber
Art��gom3to�zctiau�aczgeroiessSsatinihisbtLSiaess? YES
plezsc coaplete the fdlrnc�g ixu`oimaiion:
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;30 If t�c maaager is not the sec�e Fs the operator,
Pkase list your emp3o;meas 2sistory for tbe pretio:ss fi�e (5) cezrperiod:
Bti�ess�EmoIo�mrnt Address
Da1c
far each parmer (use adrlitionsl pages if necessffiy)_
(•Vdaiden) L.a - —_. _ Duc
HoaeAddron: So-ea>eme CttS Slelc Ysp Phonel5�&r
Fc�t�amc �SddleIcitid (�Lidea7 La DatcofHrttlx
Hocc.4dd�os: SaeG:i� Gty Siate Zip PhaaeA4+mbei
Mt32`ESO7A TAX IDENI3FICATION NUMBER - p�ssuaat to thc Lau•s of �ot� 1984, Chagter SQ2, Article 8, Sutioa 2(270.72}
(Ta� Cleerana;lssuaace of Licensesj, &cepsiag authorities ere sequired to prodsde to ihe State of 2�nnesota Cammissiona of Revmu� the
NGnxusotabusiaesstsx idrn�Scationrntmba aadthe sociai sxwirynvmberof cachliaau app&caat
Uuder tbe M�iaacsot� CmverRmmt Dats Praczias pa �d shc Federsi Frivacy Aci �} 97d, we are requir�d to advise you of the follou�ing
�S�S �e use oft6e Mmnaota Tax Identificatiou Numba:
- 2his infama4on may be used to det�y the ;K or reaewst of yo�u tzccnsc za th� evart you owe Mumesats sa7es, empIoy$ s
withhdd'¢ig � motor vefiick exdse taxes,
' UPon receivmg t�s iaf�tiaa,lFie licensia8 avth�itY m�i suAPlp it oaty W�e �a Aepazuawt of Rcvrnex. However,
under the Fedaal ExcLffiegc of fnformadoa A�ment the I�partmcm of Reveaue may su�Ply this iuformation w tlu IMcnal
RevenaeSeivice. ._.. -
�a Tax IdeaU5ca6� Nssmbcs (Sat�& Use TaxN�b�C) may bc obtsiaed from tbe S�ate ofMnaesota, Buswess Rticords Deg�tmesu.
}012ivaPark Plsza (622-2%-6181�
���,��: 1- U � c � ��,T��������:-1�9o?3�SS
_ ffa M:anesofa Tax Idrntifica6on Plumba ss not requized for sbe businas bcing operated. indicste so by ptacing aa `X' ia rke box
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List zll otha oacers of the co�o: ztion:
OFFIC�R TITT,� HOM.E HO'v,� HUS�TESS DATE OF
:iA1.2� (O�cxHejd) t ADt�S5 PHO\'E PHOh� BIRTH