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98-108Council File# ip'!Q� ORIGINAL Presented By RESOLUTION CiTY OF SAINT PAUL, MINNESOTA Ordinance # 'L i% a Green Sheet # LP 50345 Referred To Committee: Date RBSOLVBD: 1 That application (ID #19970000201) for a Liquor Off Sale License(s) 2 by SELBY WINES & SPIRITS INC DBA SELBY WINES & SPIRITS at 774 3 SELBY AVE be and the same is hereby approved with the following 4 conditions: 5 1. PLANS AND FACILITY MUST BE APPRQVED BY ENVIRONMENTAL HEALTH 6 PRIOR TO OPENING. � 2. SITE PLAN AND BUILDING PLAN MUST MEET ZONING AND BUILDING 8 CODE BEFORE ESTABLISHMENT OPENS. Requested by Department of: Office of Liaense, Inspections and Environmental Protection B �.�� X ' ° ` By Approved by Form Approved by C' Attorney By: �`7i � Approved by M yor for Submission to Council ��!i'i�l�I �ia�ii► Adopted by Council: Date `� �,� \` r �� Adoption Certified by Council Secretary DEPARTMENT/OFPICElCOUNCIL DATE INITIATED ' �� LlEPlLicensing GREEN SHEET No. LP 50345 CONTACT PERSON & PHONE InibaVDat¢ InNaUDale PECIiPAAtJN GARY (612�66-9136 1 ; Cty Attomey MUST BE ON COUNCIL AGENDA BY (DATE) A �� — 2/�'1/98 pply�gEµFOR 2� Council Research ROOTIHG OROER TOTAL # OF StCaNATURE PAGES (CLIP ALt LOCATIONS FOR SiGNATURE) ACTION REQUESTED: Council approval of the foliowing license applipGon: License # 19970000201, for SELBY WINES & SPIRITS INC, Doing Business As SELBY WINES & SPIRITS, at 774 SELBY AVE, inciuding the following business iype(s): Liquor Off Sale. RECOMMENDATIONS: Approv¢(A) RejeCt(R) PERSONAL SERVICE CONTR4CTS MUSTANSWER THE FOLLOWING QUESTIONS 1. Has this perso�rtn ever worked under a contrect for fhis tlepartment� _ PLANPIING COMMISSION YES NO _ CB COMMI7TEE 2 Has ihis personJfirm ever been a city employee? CIVIL SVC CINN, YES NO 3. Ooes this person/firm possess a skill not nortnally possessed by any Curtent city employee� YES NO . is this personlfirtn a targetetl ventlol> — YES NO Explain all yes answero on separate sheet and attach to green sheet INITIATING PROBLEM, 4SSUE, OPPORTUNITY (VJho. What, When, Where, Why): RequesBng Council approvai tor Selby Wine & Spirifs, Inc. DBA Selby Wine & Spirits (Vemon Crowe, Owner) for a Liquor Off-Sale License at 774 Selby Avenue. ADVANTAGESIFAPPROVED: 4fi�'�'(:v�iS f�.µ,�sc��,cl�ai! ad�.ri��.� �� 1�9� DISADVqNTAGES IF APPROVED: .--.__...._._____ _..__.. --.__ _.__`- DISADVANTAGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) 9S-/0� >' �- � �J � � � Type of License(s) being applied for: cL�ss rII LICENSE APPLICATION CIT`Y OF SAINT PAUL Offce of Licenu, Inspections and Envimnmentat Rntection 50 A?>:r 5�. Su.:e:W Sum Jx�. \:�a:._sc a SSIO2 (61� ZY.9090 fez (61n 266912< THIS .SPPLICATION IS SUBJECI' TO REVIEW BY TFIE PUBLIC PLEASB TYPE OR PRINT IN INK y � .�i L`rsS.E Company Name: _ ��,/ 1� /it/r. % 3 S� CACpoatlon ! Pazmuship ! Sole Proprietorslvp �— If business is incorporated a ve date of incozporation: Doing Business As: ,� �.9-�i / c�,o 3' �!�/>eJ� Business Address: __ _ .7T'} ��.�--/.C�v �e�.£ - Business Phone: JheetAddcess ! � � `�/ �ry Sute 2ip Between what czoss streets is the business located� f}VGy,T i ?�a`Yi'O �£5 �ch side of tlae saeet? s�„�� . �� Are the piemises now occupied? /�� What Type of Business? /��.� Mail To Address: SReet Addcess Applican[ Informafion: Name and Tifle: x'_nlo nT Acst Home Address: _ _ Cc$6 �z - (hiaiden) C'sty Sta[e Zip at�k. C�awa-2 Last Tide Strezt Addcess � ,/' City � State �Zip � Date af Birth: 2 - -� 3-_� � Place of Binh:, /�1��•'f-f ,/V� . Homs Phone: �z-'�-Lo% c�� Aave you ever been convictrd of any felony, crime or violazion of any city ordinance other than traffic? YES _ NO � Date of arrest: Where? Chazge: �'--� � COIIV1ChOII: _. _ _ . Sentence• List tl�e names aod residences of turee persons oi good morat cuazacter, iiving wichin tt�e 7win Cicies iYie¢o Area, not reIated to che applicant or financially interested in the premises or business, who may be referred to as to the applicant's chazacter: � �' ADDRESS t,/ / / PHONE Z1� /� - �/F� ��7+� — /�eJr YYF�Y"�/� fl�� _ ' �Cei Z j Z�� 7�� .✓�� I .� i _ /1 > > I -_ .._ _� i . ! ._ n _ .. `- - - '_'z -- - Z Gvi,�-�' — List licenses which you cuirendy hold, formerly held, or may have an interest in: '�---�/�- _ Have any of the above nan�ed licenses ever been revoked? � YES ,� NO If yes, list the dates and reasons for revocaaon: Are you going to operate this business personally? � YES , NO Tf not, who will operate it? Fust Nazna � Middle Initial (hfaidm) Iast Home Address; Street Namc �� g� Dart of Birth T�p PLaxNumber r' : / , Are you going [o have a manager or assistant in this business? _ YES /� \O If the manager is not the same as the opezator, plea.=., complete the following ioformation: �T Frst Name Middle Inifial . (Maiden) Lsst DateofBirth . HomeAddress: SneetName Ciry Sta:e Trp PhoneNumber Please list your employrnent Iustory for the previous five (5) yeaz period: Business/Emolotment Address � ---� +�,-'a%ctx, �ic�r.Gctc. — Z✓� -L:lJ � yF� � �c.rsf� -- .-�; . List all other officers of the coiporation: OFFICER TITLE NAiY� (OiSce I:etd} Middle HOME BUSINESS PHONE ?;I6NE If business is a parmership, please include the following information for each partner (use additional pages if necessary): First Nazne Aoxrz Addcess: Sffeet Name Fust Name Home Address: Sveu Name HOME A�DR�SS (:Vtaiden) �ty (Maiden) Last State Zip Iasi Swe Zip DATE OF SIRT'fI Date of Birth Phone Numbec Phone Number MII�Tf�TESOTA TAX II7ENTIFICATION NUMBII2 - Pucsuant to the Laws of 2.Tinnesota, 1984, Chapter 502, Article 8, Section 2(270.72} (Taz Clearance; Issuance of Licenses), licensing authoriGes are required w provide to rhe Stase of Minnesota Commissioner of Revenue, the Minnesota business tax idenfification number and the social securiry number of each license applicant. Tl ndes tL? M;�. n?c�ta Ge�em.r�nr T�ata Prac[;r.es Act and fhn Fy]r_Tyj PRVacy Art of 1974, we are reo,uired to advise you of the following zegazding the use of the Minnesota Tax IdentiFcation Number: - This infom�ation may be used to deny the issuance or renewal.flf your license in the event you owe Minnesota sales, employei s withholding or motor vehicle ezcise taees; - Upon receiving tlris infozmation, the licensing authority wiil supply it only to the Minnesota Depazwient of Revenue. However, under the Federal Exchange of Information Ageement, the Department of Revenue may supply llus information to tfie Internai Kevenue 5ervice. Minnesota Taz Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records Depar[ment, 10 River Pazk Plaza (612-296-6181). Sociai Security Number: 5Gk' - 72- - 7� 7�= Minnesota Tax Idenufication Number: �i l{' 7.�- J �� J � If a Minnesota Taz Tdentification Number,is not required for the business being operated, indicate so by placing an "X" in the box. i � i � ♦ CERTIFICATIOY OF WORKERS' CO.TVIPENSATION COVERAGE PURSUANT TO MINNESOTA STATL3TE 176.182 I hereby certify [hat I, or my company, am in compliance with the workers' compeasation insurance coverage requiremenu of Minnesota Statuia 176182, subdivision 2. I also understand that provision of false informauon io this certification consfitutes su�cient grounds for advetse action ao�st all licenses held, in revocation and suspension of said licenses. I��at11e of InSUtanCe COii1p2II}': GG ��l��/1�f�� NCr �L itij��/'=�7✓G�i Policy\umber: ��SF/L / � Covera�e from to I have no employees covered under workers' compensation insurance ANY FALSIFICATION OF A:\'SWERS GIKEN OR MATERIAL SUBNIITTED WILL RESULT LV DENIAL OF TffiS APPLTCATION I hereby state thai I have answered all of the preceding quesaons, and that the information contained herein is true and correct to the best of my ImowleAge and belief. I heceby scatc furthec that I have rueived no money or other consideration, by way of loan, gift, contribution, or otherwise, otl�er than already disciosed in the application wiuch I herewith submiued. I.also understand this �remise may be inspected by po;ice, iue, neaich and other ciry ofticiais at any and all �s wnen t¢e businzss is in opezation. /,z��r� �`?� - ;��,u� // -l8 9� Signazure (I2EQUII2ED for all applications) Date **Note: If this applicafion is Poal/Liquor related, please contact a City of Saint Paui Heairh Inspector, Steve Olson (266-4139), to review plans. If any substantial changes to sirucaue are.anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply for buIlding permits. If there are any changes to the parking lot, floor space, or for new operaHons, please contact a City of Saint Paui Zoning Inspector at 266-9008. Addilionai application requirements, please attach: A detailed description of the design,location and square footage of the premises to be licensed (sife plan). The following data should be on the sife plan (preferably on an 8 ll2" x 11" or 81/2" x 14" paper): - Nazne, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicafed toward the top. - Placement of ati pertinent features of the interior of fhe licensed facility such as seating azeas, Idtchens, offices, repair area, pazldng, rest rooms, efc - If a request is for an addition or expansion of the licensed facility, indicate both the current azea and the proposed expansiom A copy of your lease agreement or proof of ownership of the propertp. FOR SPECIP'IC APPLICATTON REQUIREMENTS, PLEASE SEE REVERSE >>>>, Council File# ip'!Q� ORIGINAL Presented By RESOLUTION CiTY OF SAINT PAUL, MINNESOTA Ordinance # 'L i% a Green Sheet # LP 50345 Referred To Committee: Date RBSOLVBD: 1 That application (ID #19970000201) for a Liquor Off Sale License(s) 2 by SELBY WINES & SPIRITS INC DBA SELBY WINES & SPIRITS at 774 3 SELBY AVE be and the same is hereby approved with the following 4 conditions: 5 1. PLANS AND FACILITY MUST BE APPRQVED BY ENVIRONMENTAL HEALTH 6 PRIOR TO OPENING. � 2. SITE PLAN AND BUILDING PLAN MUST MEET ZONING AND BUILDING 8 CODE BEFORE ESTABLISHMENT OPENS. Requested by Department of: Office of Liaense, Inspections and Environmental Protection B �.�� X ' ° ` By Approved by Form Approved by C' Attorney By: �`7i � Approved by M yor for Submission to Council ��!i'i�l�I �ia�ii► Adopted by Council: Date `� �,� \` r �� Adoption Certified by Council Secretary DEPARTMENT/OFPICElCOUNCIL DATE INITIATED ' �� LlEPlLicensing GREEN SHEET No. LP 50345 CONTACT PERSON & PHONE InibaVDat¢ InNaUDale PECIiPAAtJN GARY (612�66-9136 1 ; Cty Attomey MUST BE ON COUNCIL AGENDA BY (DATE) A �� — 2/�'1/98 pply�gEµFOR 2� Council Research ROOTIHG OROER TOTAL # OF StCaNATURE PAGES (CLIP ALt LOCATIONS FOR SiGNATURE) ACTION REQUESTED: Council approval of the foliowing license applipGon: License # 19970000201, for SELBY WINES & SPIRITS INC, Doing Business As SELBY WINES & SPIRITS, at 774 SELBY AVE, inciuding the following business iype(s): Liquor Off Sale. RECOMMENDATIONS: Approv¢(A) RejeCt(R) PERSONAL SERVICE CONTR4CTS MUSTANSWER THE FOLLOWING QUESTIONS 1. Has this perso�rtn ever worked under a contrect for fhis tlepartment� _ PLANPIING COMMISSION YES NO _ CB COMMI7TEE 2 Has ihis personJfirm ever been a city employee? CIVIL SVC CINN, YES NO 3. Ooes this person/firm possess a skill not nortnally possessed by any Curtent city employee� YES NO . is this personlfirtn a targetetl ventlol> — YES NO Explain all yes answero on separate sheet and attach to green sheet INITIATING PROBLEM, 4SSUE, OPPORTUNITY (VJho. What, When, Where, Why): RequesBng Council approvai tor Selby Wine & Spirifs, Inc. DBA Selby Wine & Spirits (Vemon Crowe, Owner) for a Liquor Off-Sale License at 774 Selby Avenue. ADVANTAGESIFAPPROVED: 4fi�'�'(:v�iS f�.µ,�sc��,cl�ai! ad�.ri��.� �� 1�9� DISADVqNTAGES IF APPROVED: .--.__...._._____ _..__.. --.__ _.__`- DISADVANTAGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) 9S-/0� >' �- � �J � � � Type of License(s) being applied for: cL�ss rII LICENSE APPLICATION CIT`Y OF SAINT PAUL Offce of Licenu, Inspections and Envimnmentat Rntection 50 A?>:r 5�. Su.:e:W Sum Jx�. \:�a:._sc a SSIO2 (61� ZY.9090 fez (61n 266912< THIS .SPPLICATION IS SUBJECI' TO REVIEW BY TFIE PUBLIC PLEASB TYPE OR PRINT IN INK y � .�i L`rsS.E Company Name: _ ��,/ 1� /it/r. % 3 S� CACpoatlon ! Pazmuship ! Sole Proprietorslvp �— If business is incorporated a ve date of incozporation: Doing Business As: ,� �.9-�i / c�,o 3' �!�/>eJ� Business Address: __ _ .7T'} ��.�--/.C�v �e�.£ - Business Phone: JheetAddcess ! � � `�/ �ry Sute 2ip Between what czoss streets is the business located� f}VGy,T i ?�a`Yi'O �£5 �ch side of tlae saeet? s�„�� . �� Are the piemises now occupied? /�� What Type of Business? /��.� Mail To Address: SReet Addcess Applican[ Informafion: Name and Tifle: x'_nlo nT Acst Home Address: _ _ Cc$6 �z - (hiaiden) C'sty Sta[e Zip at�k. C�awa-2 Last Tide Strezt Addcess � ,/' City � State �Zip � Date af Birth: 2 - -� 3-_� � Place of Binh:, /�1��•'f-f ,/V� . Homs Phone: �z-'�-Lo% c�� Aave you ever been convictrd of any felony, crime or violazion of any city ordinance other than traffic? YES _ NO � Date of arrest: Where? Chazge: �'--� � COIIV1ChOII: _. _ _ . Sentence• List tl�e names aod residences of turee persons oi good morat cuazacter, iiving wichin tt�e 7win Cicies iYie¢o Area, not reIated to che applicant or financially interested in the premises or business, who may be referred to as to the applicant's chazacter: � �' ADDRESS t,/ / / PHONE Z1� /� - �/F� ��7+� — /�eJr YYF�Y"�/� fl�� _ ' �Cei Z j Z�� 7�� .✓�� I .� i _ /1 > > I -_ .._ _� i . ! ._ n _ .. `- - - '_'z -- - Z Gvi,�-�' — List licenses which you cuirendy hold, formerly held, or may have an interest in: '�---�/�- _ Have any of the above nan�ed licenses ever been revoked? � YES ,� NO If yes, list the dates and reasons for revocaaon: Are you going to operate this business personally? � YES , NO Tf not, who will operate it? Fust Nazna � Middle Initial (hfaidm) Iast Home Address; Street Namc �� g� Dart of Birth T�p PLaxNumber r' : / , Are you going [o have a manager or assistant in this business? _ YES /� \O If the manager is not the same as the opezator, plea.=., complete the following ioformation: �T Frst Name Middle Inifial . (Maiden) Lsst DateofBirth . HomeAddress: SneetName Ciry Sta:e Trp PhoneNumber Please list your employrnent Iustory for the previous five (5) yeaz period: Business/Emolotment Address � ---� +�,-'a%ctx, �ic�r.Gctc. — Z✓� -L:lJ � yF� � �c.rsf� -- .-�; . List all other officers of the coiporation: OFFICER TITLE NAiY� (OiSce I:etd} Middle HOME BUSINESS PHONE ?;I6NE If business is a parmership, please include the following information for each partner (use additional pages if necessary): First Nazne Aoxrz Addcess: Sffeet Name Fust Name Home Address: Sveu Name HOME A�DR�SS (:Vtaiden) �ty (Maiden) Last State Zip Iasi Swe Zip DATE OF SIRT'fI Date of Birth Phone Numbec Phone Number MII�Tf�TESOTA TAX II7ENTIFICATION NUMBII2 - Pucsuant to the Laws of 2.Tinnesota, 1984, Chapter 502, Article 8, Section 2(270.72} (Taz Clearance; Issuance of Licenses), licensing authoriGes are required w provide to rhe Stase of Minnesota Commissioner of Revenue, the Minnesota business tax idenfification number and the social securiry number of each license applicant. Tl ndes tL? M;�. n?c�ta Ge�em.r�nr T�ata Prac[;r.es Act and fhn Fy]r_Tyj PRVacy Art of 1974, we are reo,uired to advise you of the following zegazding the use of the Minnesota Tax IdentiFcation Number: - This infom�ation may be used to deny the issuance or renewal.flf your license in the event you owe Minnesota sales, employei s withholding or motor vehicle ezcise taees; - Upon receiving tlris infozmation, the licensing authority wiil supply it only to the Minnesota Depazwient of Revenue. However, under the Federal Exchange of Information Ageement, the Department of Revenue may supply llus information to tfie Internai Kevenue 5ervice. Minnesota Taz Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records Depar[ment, 10 River Pazk Plaza (612-296-6181). Sociai Security Number: 5Gk' - 72- - 7� 7�= Minnesota Tax Idenufication Number: �i l{' 7.�- J �� J � If a Minnesota Taz Tdentification Number,is not required for the business being operated, indicate so by placing an "X" in the box. i � i � ♦ CERTIFICATIOY OF WORKERS' CO.TVIPENSATION COVERAGE PURSUANT TO MINNESOTA STATL3TE 176.182 I hereby certify [hat I, or my company, am in compliance with the workers' compeasation insurance coverage requiremenu of Minnesota Statuia 176182, subdivision 2. I also understand that provision of false informauon io this certification consfitutes su�cient grounds for advetse action ao�st all licenses held, in revocation and suspension of said licenses. I��at11e of InSUtanCe COii1p2II}': GG ��l��/1�f�� NCr �L itij��/'=�7✓G�i Policy\umber: ��SF/L / � Covera�e from to I have no employees covered under workers' compensation insurance ANY FALSIFICATION OF A:\'SWERS GIKEN OR MATERIAL SUBNIITTED WILL RESULT LV DENIAL OF TffiS APPLTCATION I hereby state thai I have answered all of the preceding quesaons, and that the information contained herein is true and correct to the best of my ImowleAge and belief. I heceby scatc furthec that I have rueived no money or other consideration, by way of loan, gift, contribution, or otherwise, otl�er than already disciosed in the application wiuch I herewith submiued. I.also understand this �remise may be inspected by po;ice, iue, neaich and other ciry ofticiais at any and all �s wnen t¢e businzss is in opezation. /,z��r� �`?� - ;��,u� // -l8 9� Signazure (I2EQUII2ED for all applications) Date **Note: If this applicafion is Poal/Liquor related, please contact a City of Saint Paui Heairh Inspector, Steve Olson (266-4139), to review plans. If any substantial changes to sirucaue are.anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply for buIlding permits. If there are any changes to the parking lot, floor space, or for new operaHons, please contact a City of Saint Paui Zoning Inspector at 266-9008. Addilionai application requirements, please attach: A detailed description of the design,location and square footage of the premises to be licensed (sife plan). The following data should be on the sife plan (preferably on an 8 ll2" x 11" or 81/2" x 14" paper): - Nazne, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicafed toward the top. - Placement of ati pertinent features of the interior of fhe licensed facility such as seating azeas, Idtchens, offices, repair area, pazldng, rest rooms, efc - If a request is for an addition or expansion of the licensed facility, indicate both the current azea and the proposed expansiom A copy of your lease agreement or proof of ownership of the propertp. FOR SPECIP'IC APPLICATTON REQUIREMENTS, PLEASE SEE REVERSE >>>>, Council File# ip'!Q� ORIGINAL Presented By RESOLUTION CiTY OF SAINT PAUL, MINNESOTA Ordinance # 'L i% a Green Sheet # LP 50345 Referred To Committee: Date RBSOLVBD: 1 That application (ID #19970000201) for a Liquor Off Sale License(s) 2 by SELBY WINES & SPIRITS INC DBA SELBY WINES & SPIRITS at 774 3 SELBY AVE be and the same is hereby approved with the following 4 conditions: 5 1. PLANS AND FACILITY MUST BE APPRQVED BY ENVIRONMENTAL HEALTH 6 PRIOR TO OPENING. � 2. SITE PLAN AND BUILDING PLAN MUST MEET ZONING AND BUILDING 8 CODE BEFORE ESTABLISHMENT OPENS. Requested by Department of: Office of Liaense, Inspections and Environmental Protection B �.�� X ' ° ` By Approved by Form Approved by C' Attorney By: �`7i � Approved by M yor for Submission to Council ��!i'i�l�I �ia�ii► Adopted by Council: Date `� �,� \` r �� Adoption Certified by Council Secretary DEPARTMENT/OFPICElCOUNCIL DATE INITIATED ' �� LlEPlLicensing GREEN SHEET No. LP 50345 CONTACT PERSON & PHONE InibaVDat¢ InNaUDale PECIiPAAtJN GARY (612�66-9136 1 ; Cty Attomey MUST BE ON COUNCIL AGENDA BY (DATE) A �� — 2/�'1/98 pply�gEµFOR 2� Council Research ROOTIHG OROER TOTAL # OF StCaNATURE PAGES (CLIP ALt LOCATIONS FOR SiGNATURE) ACTION REQUESTED: Council approval of the foliowing license applipGon: License # 19970000201, for SELBY WINES & SPIRITS INC, Doing Business As SELBY WINES & SPIRITS, at 774 SELBY AVE, inciuding the following business iype(s): Liquor Off Sale. RECOMMENDATIONS: Approv¢(A) RejeCt(R) PERSONAL SERVICE CONTR4CTS MUSTANSWER THE FOLLOWING QUESTIONS 1. Has this perso�rtn ever worked under a contrect for fhis tlepartment� _ PLANPIING COMMISSION YES NO _ CB COMMI7TEE 2 Has ihis personJfirm ever been a city employee? CIVIL SVC CINN, YES NO 3. Ooes this person/firm possess a skill not nortnally possessed by any Curtent city employee� YES NO . is this personlfirtn a targetetl ventlol> — YES NO Explain all yes answero on separate sheet and attach to green sheet INITIATING PROBLEM, 4SSUE, OPPORTUNITY (VJho. What, When, Where, Why): RequesBng Council approvai tor Selby Wine & Spirifs, Inc. DBA Selby Wine & Spirits (Vemon Crowe, Owner) for a Liquor Off-Sale License at 774 Selby Avenue. ADVANTAGESIFAPPROVED: 4fi�'�'(:v�iS f�.µ,�sc��,cl�ai! ad�.ri��.� �� 1�9� DISADVqNTAGES IF APPROVED: .--.__...._._____ _..__.. --.__ _.__`- DISADVANTAGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) 9S-/0� >' �- � �J � � � Type of License(s) being applied for: cL�ss rII LICENSE APPLICATION CIT`Y OF SAINT PAUL Offce of Licenu, Inspections and Envimnmentat Rntection 50 A?>:r 5�. Su.:e:W Sum Jx�. \:�a:._sc a SSIO2 (61� ZY.9090 fez (61n 266912< THIS .SPPLICATION IS SUBJECI' TO REVIEW BY TFIE PUBLIC PLEASB TYPE OR PRINT IN INK y � .�i L`rsS.E Company Name: _ ��,/ 1� /it/r. % 3 S� CACpoatlon ! Pazmuship ! Sole Proprietorslvp �— If business is incorporated a ve date of incozporation: Doing Business As: ,� �.9-�i / c�,o 3' �!�/>eJ� Business Address: __ _ .7T'} ��.�--/.C�v �e�.£ - Business Phone: JheetAddcess ! � � `�/ �ry Sute 2ip Between what czoss streets is the business located� f}VGy,T i ?�a`Yi'O �£5 �ch side of tlae saeet? s�„�� . �� Are the piemises now occupied? /�� What Type of Business? /��.� Mail To Address: SReet Addcess Applican[ Informafion: Name and Tifle: x'_nlo nT Acst Home Address: _ _ Cc$6 �z - (hiaiden) C'sty Sta[e Zip at�k. C�awa-2 Last Tide Strezt Addcess � ,/' City � State �Zip � Date af Birth: 2 - -� 3-_� � Place of Binh:, /�1��•'f-f ,/V� . Homs Phone: �z-'�-Lo% c�� Aave you ever been convictrd of any felony, crime or violazion of any city ordinance other than traffic? YES _ NO � Date of arrest: Where? Chazge: �'--� � COIIV1ChOII: _. _ _ . Sentence• List tl�e names aod residences of turee persons oi good morat cuazacter, iiving wichin tt�e 7win Cicies iYie¢o Area, not reIated to che applicant or financially interested in the premises or business, who may be referred to as to the applicant's chazacter: � �' ADDRESS t,/ / / PHONE Z1� /� - �/F� ��7+� — /�eJr YYF�Y"�/� fl�� _ ' �Cei Z j Z�� 7�� .✓�� I .� i _ /1 > > I -_ .._ _� i . ! ._ n _ .. `- - - '_'z -- - Z Gvi,�-�' — List licenses which you cuirendy hold, formerly held, or may have an interest in: '�---�/�- _ Have any of the above nan�ed licenses ever been revoked? � YES ,� NO If yes, list the dates and reasons for revocaaon: Are you going to operate this business personally? � YES , NO Tf not, who will operate it? Fust Nazna � Middle Initial (hfaidm) Iast Home Address; Street Namc �� g� Dart of Birth T�p PLaxNumber r' : / , Are you going [o have a manager or assistant in this business? _ YES /� \O If the manager is not the same as the opezator, plea.=., complete the following ioformation: �T Frst Name Middle Inifial . (Maiden) Lsst DateofBirth . HomeAddress: SneetName Ciry Sta:e Trp PhoneNumber Please list your employrnent Iustory for the previous five (5) yeaz period: Business/Emolotment Address � ---� +�,-'a%ctx, �ic�r.Gctc. — Z✓� -L:lJ � yF� � �c.rsf� -- .-�; . List all other officers of the coiporation: OFFICER TITLE NAiY� (OiSce I:etd} Middle HOME BUSINESS PHONE ?;I6NE If business is a parmership, please include the following information for each partner (use additional pages if necessary): First Nazne Aoxrz Addcess: Sffeet Name Fust Name Home Address: Sveu Name HOME A�DR�SS (:Vtaiden) �ty (Maiden) Last State Zip Iasi Swe Zip DATE OF SIRT'fI Date of Birth Phone Numbec Phone Number MII�Tf�TESOTA TAX II7ENTIFICATION NUMBII2 - Pucsuant to the Laws of 2.Tinnesota, 1984, Chapter 502, Article 8, Section 2(270.72} (Taz Clearance; Issuance of Licenses), licensing authoriGes are required w provide to rhe Stase of Minnesota Commissioner of Revenue, the Minnesota business tax idenfification number and the social securiry number of each license applicant. Tl ndes tL? M;�. n?c�ta Ge�em.r�nr T�ata Prac[;r.es Act and fhn Fy]r_Tyj PRVacy Art of 1974, we are reo,uired to advise you of the following zegazding the use of the Minnesota Tax IdentiFcation Number: - This infom�ation may be used to deny the issuance or renewal.flf your license in the event you owe Minnesota sales, employei s withholding or motor vehicle ezcise taees; - Upon receiving tlris infozmation, the licensing authority wiil supply it only to the Minnesota Depazwient of Revenue. However, under the Federal Exchange of Information Ageement, the Department of Revenue may supply llus information to tfie Internai Kevenue 5ervice. Minnesota Taz Identification Numbers (Sales & Use Tax Number) may be obtained from the State of Minnesota, Business Records Depar[ment, 10 River Pazk Plaza (612-296-6181). Sociai Security Number: 5Gk' - 72- - 7� 7�= Minnesota Tax Idenufication Number: �i l{' 7.�- J �� J � If a Minnesota Taz Tdentification Number,is not required for the business being operated, indicate so by placing an "X" in the box. i � i � ♦ CERTIFICATIOY OF WORKERS' CO.TVIPENSATION COVERAGE PURSUANT TO MINNESOTA STATL3TE 176.182 I hereby certify [hat I, or my company, am in compliance with the workers' compeasation insurance coverage requiremenu of Minnesota Statuia 176182, subdivision 2. I also understand that provision of false informauon io this certification consfitutes su�cient grounds for advetse action ao�st all licenses held, in revocation and suspension of said licenses. I��at11e of InSUtanCe COii1p2II}': GG ��l��/1�f�� NCr �L itij��/'=�7✓G�i Policy\umber: ��SF/L / � Covera�e from to I have no employees covered under workers' compensation insurance ANY FALSIFICATION OF A:\'SWERS GIKEN OR MATERIAL SUBNIITTED WILL RESULT LV DENIAL OF TffiS APPLTCATION I hereby state thai I have answered all of the preceding quesaons, and that the information contained herein is true and correct to the best of my ImowleAge and belief. I heceby scatc furthec that I have rueived no money or other consideration, by way of loan, gift, contribution, or otherwise, otl�er than already disciosed in the application wiuch I herewith submiued. I.also understand this �remise may be inspected by po;ice, iue, neaich and other ciry ofticiais at any and all �s wnen t¢e businzss is in opezation. /,z��r� �`?� - ;��,u� // -l8 9� Signazure (I2EQUII2ED for all applications) Date **Note: If this applicafion is Poal/Liquor related, please contact a City of Saint Paui Heairh Inspector, Steve Olson (266-4139), to review plans. If any substantial changes to sirucaue are.anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply for buIlding permits. If there are any changes to the parking lot, floor space, or for new operaHons, please contact a City of Saint Paui Zoning Inspector at 266-9008. Addilionai application requirements, please attach: A detailed description of the design,location and square footage of the premises to be licensed (sife plan). The following data should be on the sife plan (preferably on an 8 ll2" x 11" or 81/2" x 14" paper): - Nazne, address, and phone number. - The scale should be stated such as 1" = 20'. ^N should be indicafed toward the top. - Placement of ati pertinent features of the interior of fhe licensed facility such as seating azeas, Idtchens, offices, repair area, pazldng, rest rooms, efc - If a request is for an addition or expansion of the licensed facility, indicate both the current azea and the proposed expansiom A copy of your lease agreement or proof of ownership of the propertp. FOR SPECIP'IC APPLICATTON REQUIREMENTS, PLEASE SEE REVERSE >>>>,