The URL can be used to link to this page

97-919Council File # �� Ordinance # Green Sheet # � / �� ': �� S r Pl 't. `eo t 1 i �.r : i\ r i-„ Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA �i i 2 3 4 s 6 � s 9 io ii 12 13 14 RESOLVED: That application (ID #12099) for a Recycling Processing Center License by VEIT & Company Inc. DBA VETT Container Corp. (Greg Fahey) at 1305 Pierce Butler Route be and the same is hereby approved with the following conditions: 2. 3. The hours of operation are limited between 7:00 AM and 7:00 PM weekdays, and 8:00 AM to 4:00 PM on Saturdays. No Sunday operation will be allowed. The only exceptions to these hours will be for evening refueling and emergency access to respond to fires or a natural disaster. The license holder agrees to clean up debris from the site that blows into the adjacent neighborhood. Existing landscaping and obscuring fence shal] be maintained and in good condition. 15 16 Requested by Department of: 17 Yeas Nays Absent 18 Blakey 19 Bostr�.�om Office of License Inspectionc and 20 Harris 21 Mecrard � �e/ - Environmental Protection 22 Morton � 23 Thun� 24 Collins f 26 � ,��,,�� R g� 27 Adopted by Council: Date < BY� �'"`^' "-'-- �" "!� 28 � 29 Adoption Certified by Council Secretary 30 Form Approved by City Attorney 31 32 BY= � 1. �cr� r� ,� 1 33 � t BY= �/!/Z��✓/•�- � F . ��,.✓ _ 34 Approved by Mayor: Date �' �%1 35 36 Approved by Mayor for Submission to 3� g�, . � Council 38 By: °t'1- 9 �°! �� N�� DATEINITIATED GREEN SHEE � � �' b � LIEP/Licensin INITIAVDATE INITIAIJDATE CONTACTPERSONBPHONE �DEPpRTMENTDIRECfOR OCITYCAUNCII Christine Rozek 266-9108 N MBERFOR ��TyA��RNEV OCi7YCLEflK MUST BE ON COUNCIL AGENDA BV (DATE) , q0Ui1NG � BUDGET DIRECTOR � FIN. 8 MGT. SERVICES DIR. For hearin : `7 �3 Q ONOEF � MqYOR (OR ASSISTANij O TOTAL # OF SIGNATURE PACaES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: VEIT & Company Inc. DBA VEIT Container Corp. requests Council approval of its application for a Recycling Processing Center License located at 1305 Pierce Butler Route (ID �I12099). RECOMMEHDATIONS: npprove (A) or Reject (R) pEHSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSIpN 1. Has this person/firm ever worked under a contract for this department? _ CIB COMMITfEE _ YES NO _ STAFF 2. Has this perso�firm ever been a ci[y employee? — YES NO _ DISTRIC7 CAURT _ 3. Does this personRirm possess a skill not normally possessed by any current city employee? SUPPORTS WHICH COUNCIL OBJECT7VE? YES NO Explatn all yea answera o� aeparete sheet and attach tu green sheet INITIATING PR08lEM, i$SUE, �PPORTUNfN (Who. What, Wl�en, Whe�e, Why): � { � 3 � �t u � � ��Rc �,: u �'r � JUN ? 0 1897 �� .,� ADVANTACaESIFAPPROVED: �� ✓t �� $ � �� /G �� 6� �,�,� ��G DISADVANTAGES IF APPpOVED 5., wil:rz� . �1'r+ 6�.�! JUL G � .. .,I �_ �, DISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OFTRANSACTION $ COS7/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDIWG SOUHCE ACTIVITV NUMBER FINANCIAL INFORHiATION� (EXPLAIN) Greensheet # 37964 L.I.E.P. REVIEW CHECKLIST Date: 2�14/97 �� `�tq In Trackef? App'n Received / Appb Processed LicenselD # 12099 License Type: Recycling Processing Center Corttp3ny Neme: VEIT & Companv Inc. DBA: VEIT Container Corp Business Addresss: 1305 Pierce Butler Route Business Phone: 428-2242 Contact Name/Address: Greg Fahey, 1619 Hubbard Ave 9l4 Home Phone: 646-7040 55104 Date to Council Research: Pubiic Hearing Dffie: � 2.3 Notice Sent to Applicant: � 4� .� 18M. �7�/�t, Notice Sent to Public: �� `� � Labels Ordered: DiStrict Council #: / � Ward #: � Department/ Date Inspections Comments City Attorney �D'�'��' �� . Environmental Health N•#�• Fire 10•�•��` D�'. License s�te aian aeceived:_ �ease aecet�ed: n ��I �� o,� Police �' ' t �� ' Zoning (�• �' fl,� - T CLASS III LICENSE APPLICATION Type of License(s) being applied for. TYPE OR PRINT IN INK CITY OF SAINT PAUL �ce of Licrnu, Inspections ana Enwonma,w rro[ecL;on 350 SL Pcla St Stifc 300 SmrtPUil,!Vfmnesota SSiOY (61ZJ76b9J90 fuCb1�3669134 .q � ��J S Company Name: S/T � 7 � - ��'e ( 'c��A�l7o�/ ��on / Pertnetship / Sole ProQrietorslup If business is incorporated, Doing Business As: !/ Business Address: _ _ /� � date r sra,naa,�j3�s Y�ec� Between what cross strcets is the business located7 Aze the premi.ses now occupiedl Mail To Address: Type of Business7 Business Pho G/ GJy�6" :r�S /1'�!� S� c;ry �SG _ s+�co z;p Which side of the street? ! St(ectAddreae City Sinte Z�p Applicant Information: �-�,�- Natne and Title: �°� <-x �� ' ��' Fisat ddle � � / (Maiden) Lert TiUe Home Address: /�3 � �� ///�' �'P"� �� SS 3G 2, s� drU., c;ry sm� z;p Date of Birth: /y S G Place of Birth: �rn�/UiecF. Home Phone: /G�Z��"� � Rave you ever been com'icted of any felony, crime or violation of any city ordinance other than ll a11ic? � i30 �C Date of azresi: Charge: _ Conviction: Sentence: Lis[ the nam� and residences of three persons of good moral chazacter, living within the Twin Cities Metro Area, not related to the applicant or Snancially interesied in the premises or business, who may be referred to as to the applicant's chazacter: licenses which you currrntly hold, formerly held, or may have an interest in: / /� %tsc /�N�+�.2, �,�,sc7°'2, ��,'�arr�•-c �f¢rstY/Z, .Tnflto.J.C.cF�vcL 7'sL /�f YHt�"ro,�zd �r�tt� Have azry of the above nazned licenses ever bcen revoked7 YES _�_ NO If yes, lisl the dates and reasons for revocation: Where4 2/18/97 THIS APPLICATION IS SUBJECT TO RE�W BY TF� PUBLIC Are you going to operate this business personally7 � YES _ Firs[Name MidAeInitinl (.Maidm) Home Addrnr. SVeet 7�ame City Are yw going to have a m�aga or assistant in this basiness? � YES ptease complete the following information: Furt Name hfiddlc IniGal (!�faidrn) Home Addrcu: Suea I:ame Please list your employmrnt history for the previous five (5) }�eaz period: Address sft-�n-� Statt ' Zip .._� � q� •�Rl°) Detc of Binh NO If the manager is not the sazne as the operator, !� Statc Zip List all other officers of the corporation: OFFICER TITLE HOME NAME (Office Held) ADDRESS 1Gu.�� d� r G�v K-A�CH'L� �IZ4.S NO If nof, who wnll opecate it? HOME PHONE BUSINESS PHONE jy +(L$-LU(L Dste of Binh Phone Numba DAI'E OF BIItTH �� c� J'�-r J. P2�. ,r If business is a partnership, please include the following information for each partner (use additional pages if necessary): FitLL Nme MidNe Initid (Meidrn) Lut Date of $iM Home Addreee: Strxet I�'eme F'urt t�'ame Sveet City Middle Initial ��) City Sute Zip I.ss[ State Zip Phone Numba Date of Birth Phone Nvm6er MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, SecUon 2(270.72) (T� Cle�czece; Issuznce of Licenses), licensing autLorities aze required to provide to ttie State of Minnesota Commissioner of Revenue, the M+nnesotn business ta�c identification number and the social securiry number of each license apglicant Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regazding the use of the Minnesota Tax Identification Number; - 71us infotmation may be used to deny the issuance or reaewal of your license in the event you owe Minnesota sales, employer s withholding or motor vehicle excise taxes; - ilpon xeceivsng this information, the licensing authority will supply it only to the Minnesota Depaztment of Revenue. However, under the Federal Exchange of Information Agreemrn� the Department of Revenue may supply ttris information to the Intemal Revenue Service. Mumesota Tax IdentiScation NimiLbers (Sales & Use Tax Number) may be obtained 5um the State of Minnesota, Business Recozds Department, 10 River Park Plaz� (612-296-6181). Sceial Security Number: y/ �� 3 7 I� Minnesota Zax Identification Number: o _ Ka Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. 2p 8/97 Council File # �� Ordinance # Green Sheet # � / �� ': �� S r Pl 't. `eo t 1 i �.r : i\ r i-„ Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA �i i 2 3 4 s 6 � s 9 io ii 12 13 14 RESOLVED: That application (ID #12099) for a Recycling Processing Center License by VEIT & Company Inc. DBA VETT Container Corp. (Greg Fahey) at 1305 Pierce Butler Route be and the same is hereby approved with the following conditions: 2. 3. The hours of operation are limited between 7:00 AM and 7:00 PM weekdays, and 8:00 AM to 4:00 PM on Saturdays. No Sunday operation will be allowed. The only exceptions to these hours will be for evening refueling and emergency access to respond to fires or a natural disaster. The license holder agrees to clean up debris from the site that blows into the adjacent neighborhood. Existing landscaping and obscuring fence shal] be maintained and in good condition. 15 16 Requested by Department of: 17 Yeas Nays Absent 18 Blakey 19 Bostr�.�om Office of License Inspectionc and 20 Harris 21 Mecrard � �e/ - Environmental Protection 22 Morton � 23 Thun� 24 Collins f 26 � ,��,,�� R g� 27 Adopted by Council: Date < BY� �'"`^' "-'-- �" "!� 28 � 29 Adoption Certified by Council Secretary 30 Form Approved by City Attorney 31 32 BY= � 1. �cr� r� ,� 1 33 � t BY= �/!/Z��✓/•�- � F . ��,.✓ _ 34 Approved by Mayor: Date �' �%1 35 36 Approved by Mayor for Submission to 3� g�, . � Council 38 By: °t'1- 9 �°! �� N�� DATEINITIATED GREEN SHEE � � �' b � LIEP/Licensin INITIAVDATE INITIAIJDATE CONTACTPERSONBPHONE �DEPpRTMENTDIRECfOR OCITYCAUNCII Christine Rozek 266-9108 N MBERFOR ��TyA��RNEV OCi7YCLEflK MUST BE ON COUNCIL AGENDA BV (DATE) , q0Ui1NG � BUDGET DIRECTOR � FIN. 8 MGT. SERVICES DIR. For hearin : `7 �3 Q ONOEF � MqYOR (OR ASSISTANij O TOTAL # OF SIGNATURE PACaES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: VEIT & Company Inc. DBA VEIT Container Corp. requests Council approval of its application for a Recycling Processing Center License located at 1305 Pierce Butler Route (ID �I12099). RECOMMEHDATIONS: npprove (A) or Reject (R) pEHSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSIpN 1. Has this person/firm ever worked under a contract for this department? _ CIB COMMITfEE _ YES NO _ STAFF 2. Has this perso�firm ever been a ci[y employee? — YES NO _ DISTRIC7 CAURT _ 3. Does this personRirm possess a skill not normally possessed by any current city employee? SUPPORTS WHICH COUNCIL OBJECT7VE? YES NO Explatn all yea answera o� aeparete sheet and attach tu green sheet INITIATING PR08lEM, i$SUE, �PPORTUNfN (Who. What, Wl�en, Whe�e, Why): � { � 3 � �t u � � ��Rc �,: u �'r � JUN ? 0 1897 �� .,� ADVANTACaESIFAPPROVED: �� ✓t �� $ � �� /G �� 6� �,�,� ��G DISADVANTAGES IF APPpOVED 5., wil:rz� . �1'r+ 6�.�! JUL G � .. .,I �_ �, DISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OFTRANSACTION $ COS7/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDIWG SOUHCE ACTIVITV NUMBER FINANCIAL INFORHiATION� (EXPLAIN) Greensheet # 37964 L.I.E.P. REVIEW CHECKLIST Date: 2�14/97 �� `�tq In Trackef? App'n Received / Appb Processed LicenselD # 12099 License Type: Recycling Processing Center Corttp3ny Neme: VEIT & Companv Inc. DBA: VEIT Container Corp Business Addresss: 1305 Pierce Butler Route Business Phone: 428-2242 Contact Name/Address: Greg Fahey, 1619 Hubbard Ave 9l4 Home Phone: 646-7040 55104 Date to Council Research: Pubiic Hearing Dffie: � 2.3 Notice Sent to Applicant: � 4� .� 18M. �7�/�t, Notice Sent to Public: �� `� � Labels Ordered: DiStrict Council #: / � Ward #: � Department/ Date Inspections Comments City Attorney �D'�'��' �� . Environmental Health N•#�• Fire 10•�•��` D�'. License s�te aian aeceived:_ �ease aecet�ed: n ��I �� o,� Police �' ' t �� ' Zoning (�• �' fl,� - T CLASS III LICENSE APPLICATION Type of License(s) being applied for. TYPE OR PRINT IN INK CITY OF SAINT PAUL �ce of Licrnu, Inspections ana Enwonma,w rro[ecL;on 350 SL Pcla St Stifc 300 SmrtPUil,!Vfmnesota SSiOY (61ZJ76b9J90 fuCb1�3669134 .q � ��J S Company Name: S/T � 7 � - ��'e ( 'c��A�l7o�/ ��on / Pertnetship / Sole ProQrietorslup If business is incorporated, Doing Business As: !/ Business Address: _ _ /� � date r sra,naa,�j3�s Y�ec� Between what cross strcets is the business located7 Aze the premi.ses now occupiedl Mail To Address: Type of Business7 Business Pho G/ GJy�6" :r�S /1'�!� S� c;ry �SG _ s+�co z;p Which side of the street? ! St(ectAddreae City Sinte Z�p Applicant Information: �-�,�- Natne and Title: �°� <-x �� ' ��' Fisat ddle � � / (Maiden) Lert TiUe Home Address: /�3 � �� ///�' �'P"� �� SS 3G 2, s� drU., c;ry sm� z;p Date of Birth: /y S G Place of Birth: �rn�/UiecF. Home Phone: /G�Z��"� � Rave you ever been com'icted of any felony, crime or violation of any city ordinance other than ll a11ic? � i30 �C Date of azresi: Charge: _ Conviction: Sentence: Lis[ the nam� and residences of three persons of good moral chazacter, living within the Twin Cities Metro Area, not related to the applicant or Snancially interesied in the premises or business, who may be referred to as to the applicant's chazacter: licenses which you currrntly hold, formerly held, or may have an interest in: / /� %tsc /�N�+�.2, �,�,sc7°'2, ��,'�arr�•-c �f¢rstY/Z, .Tnflto.J.C.cF�vcL 7'sL /�f YHt�"ro,�zd �r�tt� Have azry of the above nazned licenses ever bcen revoked7 YES _�_ NO If yes, lisl the dates and reasons for revocation: Where4 2/18/97 THIS APPLICATION IS SUBJECT TO RE�W BY TF� PUBLIC Are you going to operate this business personally7 � YES _ Firs[Name MidAeInitinl (.Maidm) Home Addrnr. SVeet 7�ame City Are yw going to have a m�aga or assistant in this basiness? � YES ptease complete the following information: Furt Name hfiddlc IniGal (!�faidrn) Home Addrcu: Suea I:ame Please list your employmrnt history for the previous five (5) }�eaz period: Address sft-�n-� Statt ' Zip .._� � q� •�Rl°) Detc of Binh NO If the manager is not the sazne as the operator, !� Statc Zip List all other officers of the corporation: OFFICER TITLE HOME NAME (Office Held) ADDRESS 1Gu.�� d� r G�v K-A�CH'L� �IZ4.S NO If nof, who wnll opecate it? HOME PHONE BUSINESS PHONE jy +(L$-LU(L Dste of Binh Phone Numba DAI'E OF BIItTH �� c� J'�-r J. P2�. ,r If business is a partnership, please include the following information for each partner (use additional pages if necessary): FitLL Nme MidNe Initid (Meidrn) Lut Date of $iM Home Addreee: Strxet I�'eme F'urt t�'ame Sveet City Middle Initial ��) City Sute Zip I.ss[ State Zip Phone Numba Date of Birth Phone Nvm6er MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, SecUon 2(270.72) (T� Cle�czece; Issuznce of Licenses), licensing autLorities aze required to provide to ttie State of Minnesota Commissioner of Revenue, the M+nnesotn business ta�c identification number and the social securiry number of each license apglicant Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regazding the use of the Minnesota Tax Identification Number; - 71us infotmation may be used to deny the issuance or reaewal of your license in the event you owe Minnesota sales, employer s withholding or motor vehicle excise taxes; - ilpon xeceivsng this information, the licensing authority will supply it only to the Minnesota Depaztment of Revenue. However, under the Federal Exchange of Information Agreemrn� the Department of Revenue may supply ttris information to the Intemal Revenue Service. Mumesota Tax IdentiScation NimiLbers (Sales & Use Tax Number) may be obtained 5um the State of Minnesota, Business Recozds Department, 10 River Park Plaz� (612-296-6181). Sceial Security Number: y/ �� 3 7 I� Minnesota Zax Identification Number: o _ Ka Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. 2p 8/97 Council File # �� Ordinance # Green Sheet # � / �� ': �� S r Pl 't. `eo t 1 i �.r : i\ r i-„ Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA �i i 2 3 4 s 6 � s 9 io ii 12 13 14 RESOLVED: That application (ID #12099) for a Recycling Processing Center License by VEIT & Company Inc. DBA VETT Container Corp. (Greg Fahey) at 1305 Pierce Butler Route be and the same is hereby approved with the following conditions: 2. 3. The hours of operation are limited between 7:00 AM and 7:00 PM weekdays, and 8:00 AM to 4:00 PM on Saturdays. No Sunday operation will be allowed. The only exceptions to these hours will be for evening refueling and emergency access to respond to fires or a natural disaster. The license holder agrees to clean up debris from the site that blows into the adjacent neighborhood. Existing landscaping and obscuring fence shal] be maintained and in good condition. 15 16 Requested by Department of: 17 Yeas Nays Absent 18 Blakey 19 Bostr�.�om Office of License Inspectionc and 20 Harris 21 Mecrard � �e/ - Environmental Protection 22 Morton � 23 Thun� 24 Collins f 26 � ,��,,�� R g� 27 Adopted by Council: Date < BY� �'"`^' "-'-- �" "!� 28 � 29 Adoption Certified by Council Secretary 30 Form Approved by City Attorney 31 32 BY= � 1. �cr� r� ,� 1 33 � t BY= �/!/Z��✓/•�- � F . ��,.✓ _ 34 Approved by Mayor: Date �' �%1 35 36 Approved by Mayor for Submission to 3� g�, . � Council 38 By: °t'1- 9 �°! �� N�� DATEINITIATED GREEN SHEE � � �' b � LIEP/Licensin INITIAVDATE INITIAIJDATE CONTACTPERSONBPHONE �DEPpRTMENTDIRECfOR OCITYCAUNCII Christine Rozek 266-9108 N MBERFOR ��TyA��RNEV OCi7YCLEflK MUST BE ON COUNCIL AGENDA BV (DATE) , q0Ui1NG � BUDGET DIRECTOR � FIN. 8 MGT. SERVICES DIR. For hearin : `7 �3 Q ONOEF � MqYOR (OR ASSISTANij O TOTAL # OF SIGNATURE PACaES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: VEIT & Company Inc. DBA VEIT Container Corp. requests Council approval of its application for a Recycling Processing Center License located at 1305 Pierce Butler Route (ID �I12099). RECOMMEHDATIONS: npprove (A) or Reject (R) pEHSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVIL SERVICE COMMISSIpN 1. Has this person/firm ever worked under a contract for this department? _ CIB COMMITfEE _ YES NO _ STAFF 2. Has this perso�firm ever been a ci[y employee? — YES NO _ DISTRIC7 CAURT _ 3. Does this personRirm possess a skill not normally possessed by any current city employee? SUPPORTS WHICH COUNCIL OBJECT7VE? YES NO Explatn all yea answera o� aeparete sheet and attach tu green sheet INITIATING PR08lEM, i$SUE, �PPORTUNfN (Who. What, Wl�en, Whe�e, Why): � { � 3 � �t u � � ��Rc �,: u �'r � JUN ? 0 1897 �� .,� ADVANTACaESIFAPPROVED: �� ✓t �� $ � �� /G �� 6� �,�,� ��G DISADVANTAGES IF APPpOVED 5., wil:rz� . �1'r+ 6�.�! JUL G � .. .,I �_ �, DISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OFTRANSACTION $ COS7/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDIWG SOUHCE ACTIVITV NUMBER FINANCIAL INFORHiATION� (EXPLAIN) Greensheet # 37964 L.I.E.P. REVIEW CHECKLIST Date: 2�14/97 �� `�tq In Trackef? App'n Received / Appb Processed LicenselD # 12099 License Type: Recycling Processing Center Corttp3ny Neme: VEIT & Companv Inc. DBA: VEIT Container Corp Business Addresss: 1305 Pierce Butler Route Business Phone: 428-2242 Contact Name/Address: Greg Fahey, 1619 Hubbard Ave 9l4 Home Phone: 646-7040 55104 Date to Council Research: Pubiic Hearing Dffie: � 2.3 Notice Sent to Applicant: � 4� .� 18M. �7�/�t, Notice Sent to Public: �� `� � Labels Ordered: DiStrict Council #: / � Ward #: � Department/ Date Inspections Comments City Attorney �D'�'��' �� . Environmental Health N•#�• Fire 10•�•��` D�'. License s�te aian aeceived:_ �ease aecet�ed: n ��I �� o,� Police �' ' t �� ' Zoning (�• �' fl,� - T CLASS III LICENSE APPLICATION Type of License(s) being applied for. TYPE OR PRINT IN INK CITY OF SAINT PAUL �ce of Licrnu, Inspections ana Enwonma,w rro[ecL;on 350 SL Pcla St Stifc 300 SmrtPUil,!Vfmnesota SSiOY (61ZJ76b9J90 fuCb1�3669134 .q � ��J S Company Name: S/T � 7 � - ��'e ( 'c��A�l7o�/ ��on / Pertnetship / Sole ProQrietorslup If business is incorporated, Doing Business As: !/ Business Address: _ _ /� � date r sra,naa,�j3�s Y�ec� Between what cross strcets is the business located7 Aze the premi.ses now occupiedl Mail To Address: Type of Business7 Business Pho G/ GJy�6" :r�S /1'�!� S� c;ry �SG _ s+�co z;p Which side of the street? ! St(ectAddreae City Sinte Z�p Applicant Information: �-�,�- Natne and Title: �°� <-x �� ' ��' Fisat ddle � � / (Maiden) Lert TiUe Home Address: /�3 � �� ///�' �'P"� �� SS 3G 2, s� drU., c;ry sm� z;p Date of Birth: /y S G Place of Birth: �rn�/UiecF. Home Phone: /G�Z��"� � Rave you ever been com'icted of any felony, crime or violation of any city ordinance other than ll a11ic? � i30 �C Date of azresi: Charge: _ Conviction: Sentence: Lis[ the nam� and residences of three persons of good moral chazacter, living within the Twin Cities Metro Area, not related to the applicant or Snancially interesied in the premises or business, who may be referred to as to the applicant's chazacter: licenses which you currrntly hold, formerly held, or may have an interest in: / /� %tsc /�N�+�.2, �,�,sc7°'2, ��,'�arr�•-c �f¢rstY/Z, .Tnflto.J.C.cF�vcL 7'sL /�f YHt�"ro,�zd �r�tt� Have azry of the above nazned licenses ever bcen revoked7 YES _�_ NO If yes, lisl the dates and reasons for revocation: Where4 2/18/97 THIS APPLICATION IS SUBJECT TO RE�W BY TF� PUBLIC Are you going to operate this business personally7 � YES _ Firs[Name MidAeInitinl (.Maidm) Home Addrnr. SVeet 7�ame City Are yw going to have a m�aga or assistant in this basiness? � YES ptease complete the following information: Furt Name hfiddlc IniGal (!�faidrn) Home Addrcu: Suea I:ame Please list your employmrnt history for the previous five (5) }�eaz period: Address sft-�n-� Statt ' Zip .._� � q� •�Rl°) Detc of Binh NO If the manager is not the sazne as the operator, !� Statc Zip List all other officers of the corporation: OFFICER TITLE HOME NAME (Office Held) ADDRESS 1Gu.�� d� r G�v K-A�CH'L� �IZ4.S NO If nof, who wnll opecate it? HOME PHONE BUSINESS PHONE jy +(L$-LU(L Dste of Binh Phone Numba DAI'E OF BIItTH �� c� J'�-r J. P2�. ,r If business is a partnership, please include the following information for each partner (use additional pages if necessary): FitLL Nme MidNe Initid (Meidrn) Lut Date of $iM Home Addreee: Strxet I�'eme F'urt t�'ame Sveet City Middle Initial ��) City Sute Zip I.ss[ State Zip Phone Numba Date of Birth Phone Nvm6er MINNESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laws of Minnesota, 1984, Chapter 502, Article 8, SecUon 2(270.72) (T� Cle�czece; Issuznce of Licenses), licensing autLorities aze required to provide to ttie State of Minnesota Commissioner of Revenue, the M+nnesotn business ta�c identification number and the social securiry number of each license apglicant Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regazding the use of the Minnesota Tax Identification Number; - 71us infotmation may be used to deny the issuance or reaewal of your license in the event you owe Minnesota sales, employer s withholding or motor vehicle excise taxes; - ilpon xeceivsng this information, the licensing authority will supply it only to the Minnesota Depaztment of Revenue. However, under the Federal Exchange of Information Agreemrn� the Department of Revenue may supply ttris information to the Intemal Revenue Service. Mumesota Tax IdentiScation NimiLbers (Sales & Use Tax Number) may be obtained 5um the State of Minnesota, Business Recozds Department, 10 River Park Plaz� (612-296-6181). Sceial Security Number: y/ �� 3 7 I� Minnesota Zax Identification Number: o _ Ka Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. 2p 8/97