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97-916Council File # ��1_� Ordinance # Green Sheet # /� � �.: Presented By Referred To Committee: Date i 2 3 4 s 6 7 a 9 10 11 12 13 14 RESOLUTION CITY OF SAINT PAUL, MINNESOTA � l. The number of vehicles for sale, displayed outdoors, shall not exceed (5) five and shall be located in the display area shown on the approved site plan. 2. Five off-street pazking spaces shall be required for this use and shall be designated with painted stripes on the lot. The handicapped space shall be designated with signage displaying the international wheelchair symbol. The layout for this customer/employee parking shall be as shown on the approved site plan and the striping completed by no later than August 1, 1997. 3. There shall be no vehicte repair on this lot or in the building. 15 16 Requested by Department of: 1� Yea Navs Absent 18 B a�ev — 19 Bo5tran � Office of License Inspections and 20 HaYris —� Environmental Protection 21 Mepa� 22 Morton —� - 23 T un� e 24 Collins ✓ ��1 zs O " �� 26 27 Adopted by Council: Date BY ' 28 29 Adoption Certified by Council Secretary 3Q Form Approved by City Attorney 31 -�_-_��e��- � cv��.� 32 By: � 33 ^�, BY ^ 34 Approved by Mayor: Date t�� 35 36 Approved by Mayor for Submission to Council 37 By: 38 RESOLVED: That application (ID #63432) for a Second Hand Dealer-Motor Vehicle License by Auto Technical Inc. DBA Auto Technical Tna (Richazd V. Johnson) at 503 Cleveland Avenue North be and the same is hereby approved with the following conditions: By: 9�-qIG UEPARTMENTNFFICFJCOUNCIL DATE INITIATED 3 7 9 5 7 LIEPjLicensing GREEN SHEE CONTACT PERSON & PHONE INRIAVDATE INITIAVOATE �DEPAFiTMENTDIRECTOR �CINCOUNCIL Christine Rozek, 266-9108 "�'�" �CRYATfORNEY �cmrc�aic MUST BE ON COUNCIL AGENOA BV DATE NUYBER FOR ( � ROUTING O BUDGET DIRECTOR � FIN, & MGT. SEflVICES DIR. � OFDEfl � MAVOR (OR ASSISfANn ❑ For hearin : TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION FEQUESTED: Auto Technical Inc. DBA Auto Technical Inc. requests Council approval of its application for a Second Hand Dealer-Motor Vehicle License located at 503 Cleveland Avenue North (ID 9�63432). PECAMMENDATIONS. Approve (A) or Re�ect (R) pEpSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: __ PLANNING COMMISSIQN _ CNIL SERVICE COMMISSION �� Has this person/firm ever worked under a contrect for this department? " _CIBCAMMITfEE __ VES NO 2. Has this personHirm ever been a city employee? _ STAFF — YES NO _ DiSTRiC7 COUA7 _ 3. Does this erson/firm ossess a skill not normall � p p y possessetl by any curreM ciry employee. SUPPORTS WHICH COUNGL O&IECTNE7 YES NO - Explain all yes answers on separe[e sheet and attach to green aheet INITIATING PROBLEM, ISSIIE, OPPORTUNITY (Who, What. Wh@Fl, Where, Why)� ADVANTAGESIFAPPROVED� � � DISADVANTAGESIFAPPROVED. � � �1C��'� ��%��'� �i�fT��s° �� __..�...�—�:� DISADVANTAGES IF NOT APPROVED: � � � � � - TOTAL AMOUNT OF ipANSACTION $ COST/REVENUE BUDGE7ED (CIRCLE ONE) VES NO FUNDItiG SOURCE AC7IVITY NUMBER FINANCIAL INFORfhATIOM (EXPLAIN) Greensneet # 37957 L.I.E.P. REVIEW CHECKL1Sfi Date: s/2o/97 ��7` 9 � G ln Trackeh App'n Received / App'n Processed LicenselD # 63432 LiCense Type: Second Hand Dealer-Motor Vehicle Coittpany NarnB: Auto Technical Inc. DBA: Auto Technical Inc. Business Addresss: 503 Cleveland Avenue North Business Pfione: 590-6550 Contact Name/P.ddress: Richard Johnson, 1504 Innsbruck Dr N Home Phone: 571-3680 Fridley, MN 55432 Date to Council Research: Public Hearing Date: � Notice Sent to Applicant: � Labels Ordered: r District Council #: � ��, �� / � Notice Sent to Public: � / Ward #: �epartment/ Date Inspections Comments City Attorney �, � • `j�- O ,'� ' Environmental Health � 1� . -+v Fire �p• �!/ ' 1T � . �. . License Site Pian Received;_ I � � Lease Received: �t °� I � � Pofice (�• � " F �' � .� . Zoning �' �'�1�- o�� . _ cLass iz� LICENSE APPLICATION THIS APPLICATIOI3IS SUBJECT TO REVIEW BY TF� PUBLIC PLEASE TYPE OR PRINT IN INK Cyye of License(s) being applied for. S��,.d t-�a�.� ��z��- r �e��-� M�� atil�- �-{.�.�, w,tt �G.� �dd.-ers w�V. :v 5�.,.,...� M '�' Company Name: If business is incorporated, Coryoration / Partnttstiip / Sole Proprietonhip Doing Business As: �u Business Address �.,, date of incorporation: r' �/ E 73 �" T Sz) _� � _ r_i I.sA Shct Addreae City _( Stnte Zip Between what cross streets is the business Iocated7 �i w �.�, �I� '�' uv��v�e� hP Which side of the streei? �S� Are tl�e pretnises now occupied7 � What Type of Busin , 1 Mail To Address: � `_'l 6 � 1VlVLS �lr�n< � 4 )v�' (V � �r�C�. ��5-t 4 "! , �1 S.S'y.3 Z- Strxt Addrn� p City S�nte Zip 'Applicant Tnformatio : Name and TiUe: �y F'vat Home Address: / `7 C. Middle (Maidcn) q�•qlb CITY OF SAINT PAUL o6ce otLicenu, t„spections ��w� �� 3w u en> s� stia 300 StittPaul,lfvmooh SSIO] (61�166AN0 fixlbl])166A116 S 5 �� TiQe � s,.� a,� c� J s�� z�p Date of Birth: � P]ace ofBirlh: /,�a /� � Cv Home Phone: J� 7( 3� 8� T'--'- � e� ^ beee comicted of any felon., �z.^te er ��ola+io : �f _.; ;i^,- ordir.� r= c�'�_r'� �. _c�'rc' `.' :c :�FL` x Date of azres[: Charge: _ Conviclion: Srntence: Lis[ the nffines and residences of three persons of good moral character, living within the Twin Cities Metro Area, aot related to ihe applicant or financial7y interested in the premises or business, who may be referred to as lo the applicant's chazacter: ``_ List licenses which you Have avy of the above named licenses eva been revoked? Where? Z �r• NO If yes, list the dates and reasons for revocation: 2l18797 NAME ADDRESS PHONE Are you going to operaie this business personally7 � YES Name :.liddle (±vkidcn) Homc Ad�eas: Strttt \ame City Are you going to have a menager o�m this business7 yl YES please complete the following infocmation: Fust Name Homc Add'ev: Shect \ame CiTy NO If not, who w711 operate it? q�. q� G (,� Deie of B'vth Siate . 2ip Phonc Numba NO If the manager is not the same as the operator, Please list your emplo}ment history for the previous five (5) }'eaz period: Business/Emolo�Tnent Lisi all other officers of the corporation: OFFICER TITLE HOME NAME (OfficeHeld) , ADDRESS HOME y. PHONE `l.nwl�7c'� �r Lt Ic 7 v��C� �ll� Stnte Zip BUSINESS PHONE �i �Z �. Date of Birth Phone I�wnbcr DATE OF BIItTH If business is e partnership, please include the fol]owing information for each partner (use additional pages if necessary): F'vatI�*eme Middlelnitial (Meiden) Lo.+l DateotB'v�h Home Addrws: Sireet Neme � City Stete Zip Phane I.*umbcr Fint Wame Middle Ltilinl (Maidrn) La+[ Date of Bv1h Home Addre�a: Sirect Name City S�ete Zip Phonc Numbcr MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesot� ] 984, Chapter 502, Article 8, Seclion 2(270.72) (fax Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Comcnissioner of Revenue, the Minnesota business tax identification number and the soc:ial security number of each license applicant. Under the Minnesota Govemment Data Practices Act and tl�e Federal Privacy Aci of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer s withholding or motor vetucle excise taxes; - Upon receiving ttvs information, the licensing authority will supply it only to the Miimesota Departmrnt of Revenue. However, under ibe Fedezal Exchange of Infocmation Agreement, tbe Department of Revrnue may supply this informalion to the Intemal Revenue Service. Minnesota Tax Identification Nianbers (Sales & Use Tax Nwnber) may be obtained from the State of Minnesota, Business Aecords Department, 10 River Park Plaza (612-296-6181). Social Security Number: `t 7� � 3�i Z Z� l Minnesota Tax Identification Number: 2-0 �J `T10 �V _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an"X" in the box. M�ddle i i L 2/tsl97 Council File # ��1_� Ordinance # Green Sheet # /� � �.: Presented By Referred To Committee: Date i 2 3 4 s 6 7 a 9 10 11 12 13 14 RESOLUTION CITY OF SAINT PAUL, MINNESOTA � l. The number of vehicles for sale, displayed outdoors, shall not exceed (5) five and shall be located in the display area shown on the approved site plan. 2. Five off-street pazking spaces shall be required for this use and shall be designated with painted stripes on the lot. The handicapped space shall be designated with signage displaying the international wheelchair symbol. The layout for this customer/employee parking shall be as shown on the approved site plan and the striping completed by no later than August 1, 1997. 3. There shall be no vehicte repair on this lot or in the building. 15 16 Requested by Department of: 1� Yea Navs Absent 18 B a�ev — 19 Bo5tran � Office of License Inspections and 20 HaYris —� Environmental Protection 21 Mepa� 22 Morton —� - 23 T un� e 24 Collins ✓ ��1 zs O " �� 26 27 Adopted by Council: Date BY ' 28 29 Adoption Certified by Council Secretary 3Q Form Approved by City Attorney 31 -�_-_��e��- � cv��.� 32 By: � 33 ^�, BY ^ 34 Approved by Mayor: Date t�� 35 36 Approved by Mayor for Submission to Council 37 By: 38 RESOLVED: That application (ID #63432) for a Second Hand Dealer-Motor Vehicle License by Auto Technical Inc. DBA Auto Technical Tna (Richazd V. Johnson) at 503 Cleveland Avenue North be and the same is hereby approved with the following conditions: By: 9�-qIG UEPARTMENTNFFICFJCOUNCIL DATE INITIATED 3 7 9 5 7 LIEPjLicensing GREEN SHEE CONTACT PERSON & PHONE INRIAVDATE INITIAVOATE �DEPAFiTMENTDIRECTOR �CINCOUNCIL Christine Rozek, 266-9108 "�'�" �CRYATfORNEY �cmrc�aic MUST BE ON COUNCIL AGENOA BV DATE NUYBER FOR ( � ROUTING O BUDGET DIRECTOR � FIN, & MGT. SEflVICES DIR. � OFDEfl � MAVOR (OR ASSISfANn ❑ For hearin : TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION FEQUESTED: Auto Technical Inc. DBA Auto Technical Inc. requests Council approval of its application for a Second Hand Dealer-Motor Vehicle License located at 503 Cleveland Avenue North (ID 9�63432). PECAMMENDATIONS. Approve (A) or Re�ect (R) pEpSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: __ PLANNING COMMISSIQN _ CNIL SERVICE COMMISSION �� Has this person/firm ever worked under a contrect for this department? " _CIBCAMMITfEE __ VES NO 2. Has this personHirm ever been a city employee? _ STAFF — YES NO _ DiSTRiC7 COUA7 _ 3. Does this erson/firm ossess a skill not normall � p p y possessetl by any curreM ciry employee. SUPPORTS WHICH COUNGL O&IECTNE7 YES NO - Explain all yes answers on separe[e sheet and attach to green aheet INITIATING PROBLEM, ISSIIE, OPPORTUNITY (Who, What. Wh@Fl, Where, Why)� ADVANTAGESIFAPPROVED� � � DISADVANTAGESIFAPPROVED. � � �1C��'� ��%��'� �i�fT��s° �� __..�...�—�:� DISADVANTAGES IF NOT APPROVED: � � � � � - TOTAL AMOUNT OF ipANSACTION $ COST/REVENUE BUDGE7ED (CIRCLE ONE) VES NO FUNDItiG SOURCE AC7IVITY NUMBER FINANCIAL INFORfhATIOM (EXPLAIN) Greensneet # 37957 L.I.E.P. REVIEW CHECKL1Sfi Date: s/2o/97 ��7` 9 � G ln Trackeh App'n Received / App'n Processed LicenselD # 63432 LiCense Type: Second Hand Dealer-Motor Vehicle Coittpany NarnB: Auto Technical Inc. DBA: Auto Technical Inc. Business Addresss: 503 Cleveland Avenue North Business Pfione: 590-6550 Contact Name/P.ddress: Richard Johnson, 1504 Innsbruck Dr N Home Phone: 571-3680 Fridley, MN 55432 Date to Council Research: Public Hearing Date: � Notice Sent to Applicant: � Labels Ordered: r District Council #: � ��, �� / � Notice Sent to Public: � / Ward #: �epartment/ Date Inspections Comments City Attorney �, � • `j�- O ,'� ' Environmental Health � 1� . -+v Fire �p• �!/ ' 1T � . �. . License Site Pian Received;_ I � � Lease Received: �t °� I � � Pofice (�• � " F �' � .� . Zoning �' �'�1�- o�� . _ cLass iz� LICENSE APPLICATION THIS APPLICATIOI3IS SUBJECT TO REVIEW BY TF� PUBLIC PLEASE TYPE OR PRINT IN INK Cyye of License(s) being applied for. S��,.d t-�a�.� ��z��- r �e��-� M�� atil�- �-{.�.�, w,tt �G.� �dd.-ers w�V. :v 5�.,.,...� M '�' Company Name: If business is incorporated, Coryoration / Partnttstiip / Sole Proprietonhip Doing Business As: �u Business Address �.,, date of incorporation: r' �/ E 73 �" T Sz) _� � _ r_i I.sA Shct Addreae City _( Stnte Zip Between what cross streets is the business Iocated7 �i w �.�, �I� '�' uv��v�e� hP Which side of the streei? �S� Are tl�e pretnises now occupied7 � What Type of Busin , 1 Mail To Address: � `_'l 6 � 1VlVLS �lr�n< � 4 )v�' (V � �r�C�. ��5-t 4 "! , �1 S.S'y.3 Z- Strxt Addrn� p City S�nte Zip 'Applicant Tnformatio : Name and TiUe: �y F'vat Home Address: / `7 C. Middle (Maidcn) q�•qlb CITY OF SAINT PAUL o6ce otLicenu, t„spections ��w� �� 3w u en> s� stia 300 StittPaul,lfvmooh SSIO] (61�166AN0 fixlbl])166A116 S 5 �� TiQe � s,.� a,� c� J s�� z�p Date of Birth: � P]ace ofBirlh: /,�a /� � Cv Home Phone: J� 7( 3� 8� T'--'- � e� ^ beee comicted of any felon., �z.^te er ��ola+io : �f _.; ;i^,- ordir.� r= c�'�_r'� �. _c�'rc' `.' :c :�FL` x Date of azres[: Charge: _ Conviclion: Srntence: Lis[ the nffines and residences of three persons of good moral character, living within the Twin Cities Metro Area, aot related to ihe applicant or financial7y interested in the premises or business, who may be referred to as lo the applicant's chazacter: ``_ List licenses which you Have avy of the above named licenses eva been revoked? Where? Z �r• NO If yes, list the dates and reasons for revocation: 2l18797 NAME ADDRESS PHONE Are you going to operaie this business personally7 � YES Name :.liddle (±vkidcn) Homc Ad�eas: Strttt \ame City Are you going to have a menager o�m this business7 yl YES please complete the following infocmation: Fust Name Homc Add'ev: Shect \ame CiTy NO If not, who w711 operate it? q�. q� G (,� Deie of B'vth Siate . 2ip Phonc Numba NO If the manager is not the same as the operator, Please list your emplo}ment history for the previous five (5) }'eaz period: Business/Emolo�Tnent Lisi all other officers of the corporation: OFFICER TITLE HOME NAME (OfficeHeld) , ADDRESS HOME y. PHONE `l.nwl�7c'� �r Lt Ic 7 v��C� �ll� Stnte Zip BUSINESS PHONE �i �Z �. Date of Birth Phone I�wnbcr DATE OF BIItTH If business is e partnership, please include the fol]owing information for each partner (use additional pages if necessary): F'vatI�*eme Middlelnitial (Meiden) Lo.+l DateotB'v�h Home Addrws: Sireet Neme � City Stete Zip Phane I.*umbcr Fint Wame Middle Ltilinl (Maidrn) La+[ Date of Bv1h Home Addre�a: Sirect Name City S�ete Zip Phonc Numbcr MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesot� ] 984, Chapter 502, Article 8, Seclion 2(270.72) (fax Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Comcnissioner of Revenue, the Minnesota business tax identification number and the soc:ial security number of each license applicant. Under the Minnesota Govemment Data Practices Act and tl�e Federal Privacy Aci of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer s withholding or motor vetucle excise taxes; - Upon receiving ttvs information, the licensing authority will supply it only to the Miimesota Departmrnt of Revenue. However, under ibe Fedezal Exchange of Infocmation Agreement, tbe Department of Revrnue may supply this informalion to the Intemal Revenue Service. Minnesota Tax Identification Nianbers (Sales & Use Tax Nwnber) may be obtained from the State of Minnesota, Business Aecords Department, 10 River Park Plaza (612-296-6181). Social Security Number: `t 7� � 3�i Z Z� l Minnesota Tax Identification Number: 2-0 �J `T10 �V _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an"X" in the box. M�ddle i i L 2/tsl97 Council File # ��1_� Ordinance # Green Sheet # /� � �.: Presented By Referred To Committee: Date i 2 3 4 s 6 7 a 9 10 11 12 13 14 RESOLUTION CITY OF SAINT PAUL, MINNESOTA � l. The number of vehicles for sale, displayed outdoors, shall not exceed (5) five and shall be located in the display area shown on the approved site plan. 2. Five off-street pazking spaces shall be required for this use and shall be designated with painted stripes on the lot. The handicapped space shall be designated with signage displaying the international wheelchair symbol. The layout for this customer/employee parking shall be as shown on the approved site plan and the striping completed by no later than August 1, 1997. 3. There shall be no vehicte repair on this lot or in the building. 15 16 Requested by Department of: 1� Yea Navs Absent 18 B a�ev — 19 Bo5tran � Office of License Inspections and 20 HaYris —� Environmental Protection 21 Mepa� 22 Morton —� - 23 T un� e 24 Collins ✓ ��1 zs O " �� 26 27 Adopted by Council: Date BY ' 28 29 Adoption Certified by Council Secretary 3Q Form Approved by City Attorney 31 -�_-_��e��- � cv��.� 32 By: � 33 ^�, BY ^ 34 Approved by Mayor: Date t�� 35 36 Approved by Mayor for Submission to Council 37 By: 38 RESOLVED: That application (ID #63432) for a Second Hand Dealer-Motor Vehicle License by Auto Technical Inc. DBA Auto Technical Tna (Richazd V. Johnson) at 503 Cleveland Avenue North be and the same is hereby approved with the following conditions: By: 9�-qIG UEPARTMENTNFFICFJCOUNCIL DATE INITIATED 3 7 9 5 7 LIEPjLicensing GREEN SHEE CONTACT PERSON & PHONE INRIAVDATE INITIAVOATE �DEPAFiTMENTDIRECTOR �CINCOUNCIL Christine Rozek, 266-9108 "�'�" �CRYATfORNEY �cmrc�aic MUST BE ON COUNCIL AGENOA BV DATE NUYBER FOR ( � ROUTING O BUDGET DIRECTOR � FIN, & MGT. SEflVICES DIR. � OFDEfl � MAVOR (OR ASSISfANn ❑ For hearin : TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION FEQUESTED: Auto Technical Inc. DBA Auto Technical Inc. requests Council approval of its application for a Second Hand Dealer-Motor Vehicle License located at 503 Cleveland Avenue North (ID 9�63432). PECAMMENDATIONS. Approve (A) or Re�ect (R) pEpSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: __ PLANNING COMMISSIQN _ CNIL SERVICE COMMISSION �� Has this person/firm ever worked under a contrect for this department? " _CIBCAMMITfEE __ VES NO 2. Has this personHirm ever been a city employee? _ STAFF — YES NO _ DiSTRiC7 COUA7 _ 3. Does this erson/firm ossess a skill not normall � p p y possessetl by any curreM ciry employee. SUPPORTS WHICH COUNGL O&IECTNE7 YES NO - Explain all yes answers on separe[e sheet and attach to green aheet INITIATING PROBLEM, ISSIIE, OPPORTUNITY (Who, What. Wh@Fl, Where, Why)� ADVANTAGESIFAPPROVED� � � DISADVANTAGESIFAPPROVED. � � �1C��'� ��%��'� �i�fT��s° �� __..�...�—�:� DISADVANTAGES IF NOT APPROVED: � � � � � - TOTAL AMOUNT OF ipANSACTION $ COST/REVENUE BUDGE7ED (CIRCLE ONE) VES NO FUNDItiG SOURCE AC7IVITY NUMBER FINANCIAL INFORfhATIOM (EXPLAIN) Greensneet # 37957 L.I.E.P. REVIEW CHECKL1Sfi Date: s/2o/97 ��7` 9 � G ln Trackeh App'n Received / App'n Processed LicenselD # 63432 LiCense Type: Second Hand Dealer-Motor Vehicle Coittpany NarnB: Auto Technical Inc. DBA: Auto Technical Inc. Business Addresss: 503 Cleveland Avenue North Business Pfione: 590-6550 Contact Name/P.ddress: Richard Johnson, 1504 Innsbruck Dr N Home Phone: 571-3680 Fridley, MN 55432 Date to Council Research: Public Hearing Date: � Notice Sent to Applicant: � Labels Ordered: r District Council #: � ��, �� / � Notice Sent to Public: � / Ward #: �epartment/ Date Inspections Comments City Attorney �, � • `j�- O ,'� ' Environmental Health � 1� . -+v Fire �p• �!/ ' 1T � . �. . License Site Pian Received;_ I � � Lease Received: �t °� I � � Pofice (�• � " F �' � .� . Zoning �' �'�1�- o�� . _ cLass iz� LICENSE APPLICATION THIS APPLICATIOI3IS SUBJECT TO REVIEW BY TF� PUBLIC PLEASE TYPE OR PRINT IN INK Cyye of License(s) being applied for. S��,.d t-�a�.� ��z��- r �e��-� M�� atil�- �-{.�.�, w,tt �G.� �dd.-ers w�V. :v 5�.,.,...� M '�' Company Name: If business is incorporated, Coryoration / Partnttstiip / Sole Proprietonhip Doing Business As: �u Business Address �.,, date of incorporation: r' �/ E 73 �" T Sz) _� � _ r_i I.sA Shct Addreae City _( Stnte Zip Between what cross streets is the business Iocated7 �i w �.�, �I� '�' uv��v�e� hP Which side of the streei? �S� Are tl�e pretnises now occupied7 � What Type of Busin , 1 Mail To Address: � `_'l 6 � 1VlVLS �lr�n< � 4 )v�' (V � �r�C�. ��5-t 4 "! , �1 S.S'y.3 Z- Strxt Addrn� p City S�nte Zip 'Applicant Tnformatio : Name and TiUe: �y F'vat Home Address: / `7 C. Middle (Maidcn) q�•qlb CITY OF SAINT PAUL o6ce otLicenu, t„spections ��w� �� 3w u en> s� stia 300 StittPaul,lfvmooh SSIO] (61�166AN0 fixlbl])166A116 S 5 �� TiQe � s,.� a,� c� J s�� z�p Date of Birth: � P]ace ofBirlh: /,�a /� � Cv Home Phone: J� 7( 3� 8� T'--'- � e� ^ beee comicted of any felon., �z.^te er ��ola+io : �f _.; ;i^,- ordir.� r= c�'�_r'� �. _c�'rc' `.' :c :�FL` x Date of azres[: Charge: _ Conviclion: Srntence: Lis[ the nffines and residences of three persons of good moral character, living within the Twin Cities Metro Area, aot related to ihe applicant or financial7y interested in the premises or business, who may be referred to as lo the applicant's chazacter: ``_ List licenses which you Have avy of the above named licenses eva been revoked? Where? Z �r• NO If yes, list the dates and reasons for revocation: 2l18797 NAME ADDRESS PHONE Are you going to operaie this business personally7 � YES Name :.liddle (±vkidcn) Homc Ad�eas: Strttt \ame City Are you going to have a menager o�m this business7 yl YES please complete the following infocmation: Fust Name Homc Add'ev: Shect \ame CiTy NO If not, who w711 operate it? q�. q� G (,� Deie of B'vth Siate . 2ip Phonc Numba NO If the manager is not the same as the operator, Please list your emplo}ment history for the previous five (5) }'eaz period: Business/Emolo�Tnent Lisi all other officers of the corporation: OFFICER TITLE HOME NAME (OfficeHeld) , ADDRESS HOME y. PHONE `l.nwl�7c'� �r Lt Ic 7 v��C� �ll� Stnte Zip BUSINESS PHONE �i �Z �. Date of Birth Phone I�wnbcr DATE OF BIItTH If business is e partnership, please include the fol]owing information for each partner (use additional pages if necessary): F'vatI�*eme Middlelnitial (Meiden) Lo.+l DateotB'v�h Home Addrws: Sireet Neme � City Stete Zip Phane I.*umbcr Fint Wame Middle Ltilinl (Maidrn) La+[ Date of Bv1h Home Addre�a: Sirect Name City S�ete Zip Phonc Numbcr MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesot� ] 984, Chapter 502, Article 8, Seclion 2(270.72) (fax Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Comcnissioner of Revenue, the Minnesota business tax identification number and the soc:ial security number of each license applicant. Under the Minnesota Govemment Data Practices Act and tl�e Federal Privacy Aci of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer s withholding or motor vetucle excise taxes; - Upon receiving ttvs information, the licensing authority will supply it only to the Miimesota Departmrnt of Revenue. However, under ibe Fedezal Exchange of Infocmation Agreement, tbe Department of Revrnue may supply this informalion to the Intemal Revenue Service. Minnesota Tax Identification Nianbers (Sales & Use Tax Nwnber) may be obtained from the State of Minnesota, Business Aecords Department, 10 River Park Plaza (612-296-6181). Social Security Number: `t 7� � 3�i Z Z� l Minnesota Tax Identification Number: 2-0 �J `T10 �V _ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an"X" in the box. M�ddle i i L 2/tsl97