98-194ORIGlNAL
Presented By
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Council File��
Ordinance �
Green Sheet $ LP60028
��
Committee: Date
RESOLVED:
1 That application (ID #19970000216) for a Grocery (C), Gas Station,
2 Cigarette/Tobacco License(s) by MINI PAC INC DBA ASHLAND STATION
3 at 1170 ARCADE ST be and the same is hereby approved.
Requested by Department of:
By:
Approved by Ma�
By: �
Office of License, Ins ections and
Environmental Protection
By: �i�� � � X '" �
Borm Approved by Cit� t��
J ,
/
Y=
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date �c,_l,�\\ q��
�
Adoption Certified by Council Secretary �
DEPARTMENT/OFFICEfGWNCIL DA7EINtiwTED
UEP/Licensing GREEN SHEET No. �PSOOZS �� J `��
ONTACT PERSON & PHONE
mmauoaro a�e.voaee
UNTHER WILLIAM (BILy
(61�2669132 � C �, AKa �
ST BE ON COUNCIL AGENDA BY (DATE) �
3ltt198 �U/1','.G ( NI�FOR ❑2 CM1nGlRese2fdt
ROIRWG
OR�!
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Cau�ul appoval o(the fdbwing lia�nse appliration: License # 19970000276, for MINI PAC INC, Ddng Business As ASHLAND STATION, at 1170
ARCADE ST,'viclud'mg the fdbwi� busit�ess type(s): Grocery (C), Gas Slation, CigazetteJTobaxo.
RECOMMENDATIONS: Approve(A) Reject(R) RSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUES710NS:
7. Has ihis persoMrtn ever viorked under a conlract for this department7
PLANNING COMMISSION YES NO
_ 2. NasthispersoMrmeverbeenaciryemployee7
CIVIL SVC CINN, YES NO
. Does ihis persoMrm possess a sidll nce mrmelN possessed by am curtent city employee7
YES NO
. Is this perso�rm a targeted ve�MoR
� YES NO
Explafn all yes answers on xparrte sl�eet anA attaeh to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITY (VJho, What, When, Where, Why):
Requesting Cou�ii approval for Mini Pack, Ine. DBA Ashland Station fw a Gas Station, Grocery (C) 8 Cigarette License at t 770 Arcade Street.
ADVANTAGES IF APPROVED:
�:::..._ ..,.�._ ., _ , �. .
� 9 � $ ,� C k4 .a,'a
���°C�'� � ��3
DISADVANTAGES IF APPROVED:
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION S COSTIREVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:
(EXPLAIN)
CLASS III
LICENSE APPLICATION
T?�?S �;PPLICATICti iS SLBJECT TO RL- V1��,J BY TI-r PliBL?C
"`� : c �- F- I
L (o °�
s ,200 �
S 3t7 °b
c�-:��� -. �:�.z:
- P��? f�,�
Sole i ropr:teniip
If bisiness :s 'v�co�orated, gi� z c�ate of i,�corporation:
Dos.g Besiaess As: n 3 ��� h � :ST'��� � / Business Phone: -`�`]�
Bus:nessAdcress: __/_L(o W(, S�r 9`"�2�'l /z'T� S�5`��(°
Strcet Ad2scss City Siz:e Zi7 7 �
Beni ezn �rhat c; oss streets is the business located? � l !� /�-{-7- � a�� Which side of the street� C� 5 7
.1re tt±e przr.uses ^.ew occupied? \SJf:at T�pe of Busine _
:�ia:IToAddress: o��(� IM (`���5 r'fJ l�S�
Street Addr_ss
�� v0l�
csTy
'7�a��
a��i�ti
c�TY or� s:a�1;�_�Li,
c� �z o: r_:�= .�. _-�,� ,;.�::s
:::a Ec��co-x::azi'rc::r_ra
' =::s:`'
s: ; a..� ,t-- - -
.':?[^...:r,. : -. '.__
iG`7
`.� S
s�t� z;p
Applicant Infomiztion:
,� and Tiie: /� �CS �s t �."e� � �a � :ZO�� ! '�s
Fint Middle (�lzida�) Lut 2:tle
Home Address:
/'%. �y�5�(�` �/
StreetAddess CiTy Sta;e Zip �
Datz oY Bir�h: ��" �`�� Place of Bir[h: Home: hone: 7�7 �� ��'S�S
Ha� e; ou e•: er bezn com icted of zny felony, cnme er violat;cn of ar.y city ordir,ascz ether thaa tra..^c? YES \O L%�
Date of zrrest:
Charge; _
Conc�cUOn:
«'t,ere?
Seatence:
List the na.-nes and resideaces of three persons of good moral character, living within the T�i�in Cities Metro Area, not related to the applicant
or fin2ncially interested in the premises or business, «ho may be refetred to as to the applicant's chzracter:
NAME
List licenses ��-hich }'ou cuir tly
��t�� ��� ,
ADDRESS
, formerly hel� or may have zn interest in:
c xo �-..a- b�ri-er NR.�G�— .
Have any of the above nazned licenses e��er bcxn reti�oked7 YES
PHO?��
� — �!� � J'� �
NO If }'es, list the dates and reasons for recocation:
2/18'97
PLEASE TY�E OR PRINT N I\ {
T}pe a�Lice:+se(s)'�eia� appLed for: �� 5 ���� �� ���
Are;�uu geing ,o epe; z:z iltis busi, ess p�;sor.� ]1}�? v YL-S
Firzt �=.-�c
\5cc!e;^ :iel
(\!z[dc)
\0 Ifnct,��ho��:illopere'cit? l� —���
L�t Datc of 6i,1rt
S:z:t /`_ip --- i'::oe \an:L+cr
�� 1_` ��C ...�] c£2Z 15 :CI i,7c _c- -; �.` L 0'��."L:C7,
n..-�enc:resa: S�czt\s-e Ci;e
�^,rz; ou gc� o:o !:s��e a,^��z �:r c �sis:�:t _� ilas bu=;ncss' �YES
r�2ES0 CCS!i ��::18 ;::C ° O''C\:'^Z ,'�� :""ai;C7:
ras.\ _
\;;c�'e ?:-: zl
i�`-'�^)
'r"exc �d�'ress: Strcct\�,-�e
Ci:r
r,_ �
St� _ Zip
Plzzse list � cu e:r�lc;irient h;sion ior the previons in e(�) } zzr pe�ed:
Bns;r.zss�Emnlo�;r�er,t Addrzss
!vt l 1✓' 1 e �� � f��S'�
Fus[ tizme
Lisi sll other officz;s of the ce:porztioa:
OFFICER TITLE HOME HO.VEi BUSIAESS DATEOr
NA_'�1E (08:�Hzld) ADDRESS PHO\B PHO\'E, 7 �_� ; � S �BL�TH
h���-� �'a �z�s� J3>-�c ��'G �5 w,�,�-r�,.�� 7�y-ct� -�.. t�-��a�
/.�7� � �/`tez'1� ��� 7-�,o•-'f`�
If businzss is a pastnership, please v�ciude Lhe follo�3ir.g information for each pzrtner (use additional pages if necesszn
Strcet �eme
Fint \aeie
8
Home Addr.ss: Sireet \zme
u�aa�e v,�s�t
(�;aiden)
csTy
�iEldryl�
csry
� /��� �(��I
Lrst
Siate Zip
I,zR
Stzte Zix
� _._ :f 3:�h
i�.*,o�e \umba
Phone \umbet
Date af ainh
Phone \uaber
NiI\TA�ESOTA TAX IDENI'IFICATION A'TJ_NIBER - Pursuant to the Laws of Minnesota, 1984, Chapter �02, Article 8, Szction 2(270.72)
(I'at Clearance; Issuance of L:censes), licensing authonties are requued to provide to the State of Minnesota Commissioner of Revenve, ihe
Nunnesota business taY identifcation number and the social securiy number of each license applicant.
Under ihe Minnesota Gover.iment Data Practices Act and the Federal Pm'acy Act of 1974, ��e are required to ad�ise you ef the follo�ring
mgarding the use of the Nunnesota TaX Identificatien Number:
- Tbis information may be used to dzny the issua.nce or rene�� al of }`our license in the e� ent ; ou o��.e Minnesota sales, employer s
�.iL�holding or motor � ehicle excise taxes;
- Upon recsiving this information, the licensing aL;hority will supply it only to the :vlinnesota Department of Re�'znue. However,
under the Federal Exchange of In`ormation Agreement, the Departrnent of Revenue may supply tlus infomiation to the Intemal
Revenue Service.
?vfinnesota Tax Identification I�unbeis (Sales & Use TaK Number) may be obtained from the State of Minnesota, Business Records Dep�rtment,
10 Ri��er Park Plaza (612-296-6181). _ - - ..
Sociat Security I�TUmber: �� ��' oZ 0� f�` �7 Minnesota Ta�c Identification Nunber: ����` L U
_ If a Minnesota Tax Identificatioa Number is not required for the business being operated, indicalz so by placing an"X" in lhe box.
� 2/73%97
�lS-Iq`I
c�:�rn=lcario:�� or v,ro.�rRS� cc�;r-LVS,a rio� cov,�z,�cr Pv:z�u.�` r 7 0;�.i:.mZ:soTa s rA7uri: i;�. � sz
I;:e� zby c«tifr il�zt I, or :�:}� eea�p�rv, �m in coaipliance l�iLh u;: �. orl;e: s' con izsura; ce co� erage ; ze:�se�; �e-;s oi'.�.;i- Stz�t? �
1 i6.182, ��h�i�;soz 2. I �c� ur.d�; s:�:;: ;iszt pro��s:oa eT.`z'.:=1=oi�z�on in :}:is ce,'d5ez:ion eor.st;tu:es su��ev:, ; 2:eu�Ls `ar zcce, <z ac6on
gai;ist �il licer,ses heid, i:cha�'±ng rz� ocztie� sd cLSpza:ie� cf sz:d ]icer.ses.
\an;e ci _^srz�ce Coa:pa ;c:
?ci;ry\u*abzr: Cc�er��z`rcm ?o
I Sa��e,,o en:�,ic}ccs cccere3 �_�-cer :��ckz,s' co�:peaszi;ea � ca:a�ce (?\117Ai c)
�:\1' :�hLSIF;C.�TiO'V OF.��SW ERS GFVEi OR :�fATERL4L StiB�fiTTED
��IE,L REStiLT L\ DE!'I,�L OF THIS APrLFCAIFON
I'�ereby stzte thzt I ha�'e �r;s�'.'zred zil of :he preceding que�;�ons, znd Lhat the iafonnatien coatzined herzul is tn�z a:_d cc:Tect to Lhe best ef
*:•y kno�a ledee zr,d belizi. i hereLy state fiu'�hzr thzt I ha� e rzcei� ed no mor.ey or other considerzt±on, by �vzy of lozn, gift, conh er
o��:�; o;her tha� uezdy �sc?os�l iz �he e�plicz+uez �,'r,;ch I he-e;iiLh c�bir�ttd. I�Iso undr, stznd tlus pre*�.ise n be iaspec±ed by po';ce,
£re, heaiLh ar.d other cit�• o:£cizls at �.}' ��d aii t�r.es n hen'h� ous;ness is ;n opzrztion.
7
�. —
(REQUIIZEA?or ztl zppticztions) " IIate
FVe r�'ill accept pa}�ment Uy cash, check (made payable to CiYy of Szint Psut) or credit card (:4LC or Visa).
IF PAYING BY CREBIT CAR13 PLFASE COMPLETE THE FOLLOWING INFORMATION: � MzsterCard � Visa
EXPIRATION DATE: ACCOiJI�Tl' i�'U1ViBER: '
❑o/o❑ ❑oo❑ ❑oo❑ ❑oo❑ ❑oo❑
Cudholder
of Card Holder(required for all
•"Note: If this application is Food/Liquor related, please contect a Ciry of Saint Paul Health Inspector, Steve Olson (266-9139), to re��ew
plans.
If any substantial changes to structwe aze anticipated, please contact a City of Saint Paul PIan Exazniner at 266-9007 to apply for
building pernuts.
Ifthere are an}' changes to the parking lot, floor spzcz, or for new operations, please contact a City of Saint Paul Zoting Inspector at
266-9008.
All apptications require the foIIoning documents. Please attach these documents R�hea submitting }�our application:
]. A detailed description of the design, location znd square footage of the premises to be licensed (site plan).
The follo�i�ing data should be on the site plan (preferably on an 8 12" x 11" or 8 1/2" x I4" paper):
- Name, zddress, and phoae number.
- The scale sbould be stzted such as 1" = 20'. ^N should be indicated to���ard the top.
- Placement of all pertinent features of the interior of the licensed fzcility such as seating azeas, kitchens, off;ces, repair azea,
pzrking, rest rooms, etc.
- If a requcst is for an additioa or expansion of the licensed facility, indicate both the current area and the proposed e�pansion.
2. A copy of your lease aseement or proof of o�3�nership of the property.
SPECIFIC LICENSE AI'PLICATIONS REQiTII2E ADDTTIONAL IlVFOR't�ATION.
PLEASE SEE REVERSE FOR DETAILS >>>>
�Y.'l
�. � g,�7
ORIGlNAL
Presented By
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Council File��
Ordinance �
Green Sheet $ LP60028
��
Committee: Date
RESOLVED:
1 That application (ID #19970000216) for a Grocery (C), Gas Station,
2 Cigarette/Tobacco License(s) by MINI PAC INC DBA ASHLAND STATION
3 at 1170 ARCADE ST be and the same is hereby approved.
Requested by Department of:
By:
Approved by Ma�
By: �
Office of License, Ins ections and
Environmental Protection
By: �i�� � � X '" �
Borm Approved by Cit� t��
J ,
/
Y=
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date �c,_l,�\\ q��
�
Adoption Certified by Council Secretary �
DEPARTMENT/OFFICEfGWNCIL DA7EINtiwTED
UEP/Licensing GREEN SHEET No. �PSOOZS �� J `��
ONTACT PERSON & PHONE
mmauoaro a�e.voaee
UNTHER WILLIAM (BILy
(61�2669132 � C �, AKa �
ST BE ON COUNCIL AGENDA BY (DATE) �
3ltt198 �U/1','.G ( NI�FOR ❑2 CM1nGlRese2fdt
ROIRWG
OR�!
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Cau�ul appoval o(the fdbwing lia�nse appliration: License # 19970000276, for MINI PAC INC, Ddng Business As ASHLAND STATION, at 1170
ARCADE ST,'viclud'mg the fdbwi� busit�ess type(s): Grocery (C), Gas Slation, CigazetteJTobaxo.
RECOMMENDATIONS: Approve(A) Reject(R) RSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUES710NS:
7. Has ihis persoMrtn ever viorked under a conlract for this department7
PLANNING COMMISSION YES NO
_ 2. NasthispersoMrmeverbeenaciryemployee7
CIVIL SVC CINN, YES NO
. Does ihis persoMrm possess a sidll nce mrmelN possessed by am curtent city employee7
YES NO
. Is this perso�rm a targeted ve�MoR
� YES NO
Explafn all yes answers on xparrte sl�eet anA attaeh to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITY (VJho, What, When, Where, Why):
Requesting Cou�ii approval for Mini Pack, Ine. DBA Ashland Station fw a Gas Station, Grocery (C) 8 Cigarette License at t 770 Arcade Street.
ADVANTAGES IF APPROVED:
�:::..._ ..,.�._ ., _ , �. .
� 9 � $ ,� C k4 .a,'a
���°C�'� � ��3
DISADVANTAGES IF APPROVED:
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION S COSTIREVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:
(EXPLAIN)
CLASS III
LICENSE APPLICATION
T?�?S �;PPLICATICti iS SLBJECT TO RL- V1��,J BY TI-r PliBL?C
"`� : c �- F- I
L (o °�
s ,200 �
S 3t7 °b
c�-:��� -. �:�.z:
- P��? f�,�
Sole i ropr:teniip
If bisiness :s 'v�co�orated, gi� z c�ate of i,�corporation:
Dos.g Besiaess As: n 3 ��� h � :ST'��� � / Business Phone: -`�`]�
Bus:nessAdcress: __/_L(o W(, S�r 9`"�2�'l /z'T� S�5`��(°
Strcet Ad2scss City Siz:e Zi7 7 �
Beni ezn �rhat c; oss streets is the business located? � l !� /�-{-7- � a�� Which side of the street� C� 5 7
.1re tt±e przr.uses ^.ew occupied? \SJf:at T�pe of Busine _
:�ia:IToAddress: o��(� IM (`���5 r'fJ l�S�
Street Addr_ss
�� v0l�
csTy
'7�a��
a��i�ti
c�TY or� s:a�1;�_�Li,
c� �z o: r_:�= .�. _-�,� ,;.�::s
:::a Ec��co-x::azi'rc::r_ra
' =::s:`'
s: ; a..� ,t-- - -
.':?[^...:r,. : -. '.__
iG`7
`.� S
s�t� z;p
Applicant Infomiztion:
,� and Tiie: /� �CS �s t �."e� � �a � :ZO�� ! '�s
Fint Middle (�lzida�) Lut 2:tle
Home Address:
/'%. �y�5�(�` �/
StreetAddess CiTy Sta;e Zip �
Datz oY Bir�h: ��" �`�� Place of Bir[h: Home: hone: 7�7 �� ��'S�S
Ha� e; ou e•: er bezn com icted of zny felony, cnme er violat;cn of ar.y city ordir,ascz ether thaa tra..^c? YES \O L%�
Date of zrrest:
Charge; _
Conc�cUOn:
«'t,ere?
Seatence:
List the na.-nes and resideaces of three persons of good moral character, living within the T�i�in Cities Metro Area, not related to the applicant
or fin2ncially interested in the premises or business, «ho may be refetred to as to the applicant's chzracter:
NAME
List licenses ��-hich }'ou cuir tly
��t�� ��� ,
ADDRESS
, formerly hel� or may have zn interest in:
c xo �-..a- b�ri-er NR.�G�— .
Have any of the above nazned licenses e��er bcxn reti�oked7 YES
PHO?��
� — �!� � J'� �
NO If }'es, list the dates and reasons for recocation:
2/18'97
PLEASE TY�E OR PRINT N I\ {
T}pe a�Lice:+se(s)'�eia� appLed for: �� 5 ���� �� ���
Are;�uu geing ,o epe; z:z iltis busi, ess p�;sor.� ]1}�? v YL-S
Firzt �=.-�c
\5cc!e;^ :iel
(\!z[dc)
\0 Ifnct,��ho��:illopere'cit? l� —���
L�t Datc of 6i,1rt
S:z:t /`_ip --- i'::oe \an:L+cr
�� 1_` ��C ...�] c£2Z 15 :CI i,7c _c- -; �.` L 0'��."L:C7,
n..-�enc:resa: S�czt\s-e Ci;e
�^,rz; ou gc� o:o !:s��e a,^��z �:r c �sis:�:t _� ilas bu=;ncss' �YES
r�2ES0 CCS!i ��::18 ;::C ° O''C\:'^Z ,'�� :""ai;C7:
ras.\ _
\;;c�'e ?:-: zl
i�`-'�^)
'r"exc �d�'ress: Strcct\�,-�e
Ci:r
r,_ �
St� _ Zip
Plzzse list � cu e:r�lc;irient h;sion ior the previons in e(�) } zzr pe�ed:
Bns;r.zss�Emnlo�;r�er,t Addrzss
!vt l 1✓' 1 e �� � f��S'�
Fus[ tizme
Lisi sll other officz;s of the ce:porztioa:
OFFICER TITLE HOME HO.VEi BUSIAESS DATEOr
NA_'�1E (08:�Hzld) ADDRESS PHO\B PHO\'E, 7 �_� ; � S �BL�TH
h���-� �'a �z�s� J3>-�c ��'G �5 w,�,�-r�,.�� 7�y-ct� -�.. t�-��a�
/.�7� � �/`tez'1� ��� 7-�,o•-'f`�
If businzss is a pastnership, please v�ciude Lhe follo�3ir.g information for each pzrtner (use additional pages if necesszn
Strcet �eme
Fint \aeie
8
Home Addr.ss: Sireet \zme
u�aa�e v,�s�t
(�;aiden)
csTy
�iEldryl�
csry
� /��� �(��I
Lrst
Siate Zip
I,zR
Stzte Zix
� _._ :f 3:�h
i�.*,o�e \umba
Phone \umbet
Date af ainh
Phone \uaber
NiI\TA�ESOTA TAX IDENI'IFICATION A'TJ_NIBER - Pursuant to the Laws of Minnesota, 1984, Chapter �02, Article 8, Szction 2(270.72)
(I'at Clearance; Issuance of L:censes), licensing authonties are requued to provide to the State of Minnesota Commissioner of Revenve, ihe
Nunnesota business taY identifcation number and the social securiy number of each license applicant.
Under ihe Minnesota Gover.iment Data Practices Act and the Federal Pm'acy Act of 1974, ��e are required to ad�ise you ef the follo�ring
mgarding the use of the Nunnesota TaX Identificatien Number:
- Tbis information may be used to dzny the issua.nce or rene�� al of }`our license in the e� ent ; ou o��.e Minnesota sales, employer s
�.iL�holding or motor � ehicle excise taxes;
- Upon recsiving this information, the licensing aL;hority will supply it only to the :vlinnesota Department of Re�'znue. However,
under the Federal Exchange of In`ormation Agreement, the Departrnent of Revenue may supply tlus infomiation to the Intemal
Revenue Service.
?vfinnesota Tax Identification I�unbeis (Sales & Use TaK Number) may be obtained from the State of Minnesota, Business Records Dep�rtment,
10 Ri��er Park Plaza (612-296-6181). _ - - ..
Sociat Security I�TUmber: �� ��' oZ 0� f�` �7 Minnesota Ta�c Identification Nunber: ����` L U
_ If a Minnesota Tax Identificatioa Number is not required for the business being operated, indicalz so by placing an"X" in lhe box.
� 2/73%97
�lS-Iq`I
c�:�rn=lcario:�� or v,ro.�rRS� cc�;r-LVS,a rio� cov,�z,�cr Pv:z�u.�` r 7 0;�.i:.mZ:soTa s rA7uri: i;�. � sz
I;:e� zby c«tifr il�zt I, or :�:}� eea�p�rv, �m in coaipliance l�iLh u;: �. orl;e: s' con izsura; ce co� erage ; ze:�se�; �e-;s oi'.�.;i- Stz�t? �
1 i6.182, ��h�i�;soz 2. I �c� ur.d�; s:�:;: ;iszt pro��s:oa eT.`z'.:=1=oi�z�on in :}:is ce,'d5ez:ion eor.st;tu:es su��ev:, ; 2:eu�Ls `ar zcce, <z ac6on
gai;ist �il licer,ses heid, i:cha�'±ng rz� ocztie� sd cLSpza:ie� cf sz:d ]icer.ses.
\an;e ci _^srz�ce Coa:pa ;c:
?ci;ry\u*abzr: Cc�er��z`rcm ?o
I Sa��e,,o en:�,ic}ccs cccere3 �_�-cer :��ckz,s' co�:peaszi;ea � ca:a�ce (?\117Ai c)
�:\1' :�hLSIF;C.�TiO'V OF.��SW ERS GFVEi OR :�fATERL4L StiB�fiTTED
��IE,L REStiLT L\ DE!'I,�L OF THIS APrLFCAIFON
I'�ereby stzte thzt I ha�'e �r;s�'.'zred zil of :he preceding que�;�ons, znd Lhat the iafonnatien coatzined herzul is tn�z a:_d cc:Tect to Lhe best ef
*:•y kno�a ledee zr,d belizi. i hereLy state fiu'�hzr thzt I ha� e rzcei� ed no mor.ey or other considerzt±on, by �vzy of lozn, gift, conh er
o��:�; o;her tha� uezdy �sc?os�l iz �he e�plicz+uez �,'r,;ch I he-e;iiLh c�bir�ttd. I�Iso undr, stznd tlus pre*�.ise n be iaspec±ed by po';ce,
£re, heaiLh ar.d other cit�• o:£cizls at �.}' ��d aii t�r.es n hen'h� ous;ness is ;n opzrztion.
7
�. —
(REQUIIZEA?or ztl zppticztions) " IIate
FVe r�'ill accept pa}�ment Uy cash, check (made payable to CiYy of Szint Psut) or credit card (:4LC or Visa).
IF PAYING BY CREBIT CAR13 PLFASE COMPLETE THE FOLLOWING INFORMATION: � MzsterCard � Visa
EXPIRATION DATE: ACCOiJI�Tl' i�'U1ViBER: '
❑o/o❑ ❑oo❑ ❑oo❑ ❑oo❑ ❑oo❑
Cudholder
of Card Holder(required for all
•"Note: If this application is Food/Liquor related, please contect a Ciry of Saint Paul Health Inspector, Steve Olson (266-9139), to re��ew
plans.
If any substantial changes to structwe aze anticipated, please contact a City of Saint Paul PIan Exazniner at 266-9007 to apply for
building pernuts.
Ifthere are an}' changes to the parking lot, floor spzcz, or for new operations, please contact a City of Saint Paul Zoting Inspector at
266-9008.
All apptications require the foIIoning documents. Please attach these documents R�hea submitting }�our application:
]. A detailed description of the design, location znd square footage of the premises to be licensed (site plan).
The follo�i�ing data should be on the site plan (preferably on an 8 12" x 11" or 8 1/2" x I4" paper):
- Name, zddress, and phoae number.
- The scale sbould be stzted such as 1" = 20'. ^N should be indicated to���ard the top.
- Placement of all pertinent features of the interior of the licensed fzcility such as seating azeas, kitchens, off;ces, repair azea,
pzrking, rest rooms, etc.
- If a requcst is for an additioa or expansion of the licensed facility, indicate both the current area and the proposed e�pansion.
2. A copy of your lease aseement or proof of o�3�nership of the property.
SPECIFIC LICENSE AI'PLICATIONS REQiTII2E ADDTTIONAL IlVFOR't�ATION.
PLEASE SEE REVERSE FOR DETAILS >>>>
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ORIGlNAL
Presented By
Referred To
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
Council File��
Ordinance �
Green Sheet $ LP60028
��
Committee: Date
RESOLVED:
1 That application (ID #19970000216) for a Grocery (C), Gas Station,
2 Cigarette/Tobacco License(s) by MINI PAC INC DBA ASHLAND STATION
3 at 1170 ARCADE ST be and the same is hereby approved.
Requested by Department of:
By:
Approved by Ma�
By: �
Office of License, Ins ections and
Environmental Protection
By: �i�� � � X '" �
Borm Approved by Cit� t��
J ,
/
Y=
Approved by Mayor for Submission to
Council
By:
Adopted by Council: Date �c,_l,�\\ q��
�
Adoption Certified by Council Secretary �
DEPARTMENT/OFFICEfGWNCIL DA7EINtiwTED
UEP/Licensing GREEN SHEET No. �PSOOZS �� J `��
ONTACT PERSON & PHONE
mmauoaro a�e.voaee
UNTHER WILLIAM (BILy
(61�2669132 � C �, AKa �
ST BE ON COUNCIL AGENDA BY (DATE) �
3ltt198 �U/1','.G ( NI�FOR ❑2 CM1nGlRese2fdt
ROIRWG
OR�!
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Cau�ul appoval o(the fdbwing lia�nse appliration: License # 19970000276, for MINI PAC INC, Ddng Business As ASHLAND STATION, at 1170
ARCADE ST,'viclud'mg the fdbwi� busit�ess type(s): Grocery (C), Gas Slation, CigazetteJTobaxo.
RECOMMENDATIONS: Approve(A) Reject(R) RSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUES710NS:
7. Has ihis persoMrtn ever viorked under a conlract for this department7
PLANNING COMMISSION YES NO
_ 2. NasthispersoMrmeverbeenaciryemployee7
CIVIL SVC CINN, YES NO
. Does ihis persoMrm possess a sidll nce mrmelN possessed by am curtent city employee7
YES NO
. Is this perso�rm a targeted ve�MoR
� YES NO
Explafn all yes answers on xparrte sl�eet anA attaeh to green sheet
INITIATING PROBLEM, ISSUE, OPPORTUNITY (VJho, What, When, Where, Why):
Requesting Cou�ii approval for Mini Pack, Ine. DBA Ashland Station fw a Gas Station, Grocery (C) 8 Cigarette License at t 770 Arcade Street.
ADVANTAGES IF APPROVED:
�:::..._ ..,.�._ ., _ , �. .
� 9 � $ ,� C k4 .a,'a
���°C�'� � ��3
DISADVANTAGES IF APPROVED:
DISADVANTAGES IF NOT APPROVED:
TOTAL AMOUNT OF TRANSACTION S COSTIREVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:
(EXPLAIN)
CLASS III
LICENSE APPLICATION
T?�?S �;PPLICATICti iS SLBJECT TO RL- V1��,J BY TI-r PliBL?C
"`� : c �- F- I
L (o °�
s ,200 �
S 3t7 °b
c�-:��� -. �:�.z:
- P��? f�,�
Sole i ropr:teniip
If bisiness :s 'v�co�orated, gi� z c�ate of i,�corporation:
Dos.g Besiaess As: n 3 ��� h � :ST'��� � / Business Phone: -`�`]�
Bus:nessAdcress: __/_L(o W(, S�r 9`"�2�'l /z'T� S�5`��(°
Strcet Ad2scss City Siz:e Zi7 7 �
Beni ezn �rhat c; oss streets is the business located? � l !� /�-{-7- � a�� Which side of the street� C� 5 7
.1re tt±e przr.uses ^.ew occupied? \SJf:at T�pe of Busine _
:�ia:IToAddress: o��(� IM (`���5 r'fJ l�S�
Street Addr_ss
�� v0l�
csTy
'7�a��
a��i�ti
c�TY or� s:a�1;�_�Li,
c� �z o: r_:�= .�. _-�,� ,;.�::s
:::a Ec��co-x::azi'rc::r_ra
' =::s:`'
s: ; a..� ,t-- - -
.':?[^...:r,. : -. '.__
iG`7
`.� S
s�t� z;p
Applicant Infomiztion:
,� and Tiie: /� �CS �s t �."e� � �a � :ZO�� ! '�s
Fint Middle (�lzida�) Lut 2:tle
Home Address:
/'%. �y�5�(�` �/
StreetAddess CiTy Sta;e Zip �
Datz oY Bir�h: ��" �`�� Place of Bir[h: Home: hone: 7�7 �� ��'S�S
Ha� e; ou e•: er bezn com icted of zny felony, cnme er violat;cn of ar.y city ordir,ascz ether thaa tra..^c? YES \O L%�
Date of zrrest:
Charge; _
Conc�cUOn:
«'t,ere?
Seatence:
List the na.-nes and resideaces of three persons of good moral character, living within the T�i�in Cities Metro Area, not related to the applicant
or fin2ncially interested in the premises or business, «ho may be refetred to as to the applicant's chzracter:
NAME
List licenses ��-hich }'ou cuir tly
��t�� ��� ,
ADDRESS
, formerly hel� or may have zn interest in:
c xo �-..a- b�ri-er NR.�G�— .
Have any of the above nazned licenses e��er bcxn reti�oked7 YES
PHO?��
� — �!� � J'� �
NO If }'es, list the dates and reasons for recocation:
2/18'97
PLEASE TY�E OR PRINT N I\ {
T}pe a�Lice:+se(s)'�eia� appLed for: �� 5 ���� �� ���
Are;�uu geing ,o epe; z:z iltis busi, ess p�;sor.� ]1}�? v YL-S
Firzt �=.-�c
\5cc!e;^ :iel
(\!z[dc)
\0 Ifnct,��ho��:illopere'cit? l� —���
L�t Datc of 6i,1rt
S:z:t /`_ip --- i'::oe \an:L+cr
�� 1_` ��C ...�] c£2Z 15 :CI i,7c _c- -; �.` L 0'��."L:C7,
n..-�enc:resa: S�czt\s-e Ci;e
�^,rz; ou gc� o:o !:s��e a,^��z �:r c �sis:�:t _� ilas bu=;ncss' �YES
r�2ES0 CCS!i ��::18 ;::C ° O''C\:'^Z ,'�� :""ai;C7:
ras.\ _
\;;c�'e ?:-: zl
i�`-'�^)
'r"exc �d�'ress: Strcct\�,-�e
Ci:r
r,_ �
St� _ Zip
Plzzse list � cu e:r�lc;irient h;sion ior the previons in e(�) } zzr pe�ed:
Bns;r.zss�Emnlo�;r�er,t Addrzss
!vt l 1✓' 1 e �� � f��S'�
Fus[ tizme
Lisi sll other officz;s of the ce:porztioa:
OFFICER TITLE HOME HO.VEi BUSIAESS DATEOr
NA_'�1E (08:�Hzld) ADDRESS PHO\B PHO\'E, 7 �_� ; � S �BL�TH
h���-� �'a �z�s� J3>-�c ��'G �5 w,�,�-r�,.�� 7�y-ct� -�.. t�-��a�
/.�7� � �/`tez'1� ��� 7-�,o•-'f`�
If businzss is a pastnership, please v�ciude Lhe follo�3ir.g information for each pzrtner (use additional pages if necesszn
Strcet �eme
Fint \aeie
8
Home Addr.ss: Sireet \zme
u�aa�e v,�s�t
(�;aiden)
csTy
�iEldryl�
csry
� /��� �(��I
Lrst
Siate Zip
I,zR
Stzte Zix
� _._ :f 3:�h
i�.*,o�e \umba
Phone \umbet
Date af ainh
Phone \uaber
NiI\TA�ESOTA TAX IDENI'IFICATION A'TJ_NIBER - Pursuant to the Laws of Minnesota, 1984, Chapter �02, Article 8, Szction 2(270.72)
(I'at Clearance; Issuance of L:censes), licensing authonties are requued to provide to the State of Minnesota Commissioner of Revenve, ihe
Nunnesota business taY identifcation number and the social securiy number of each license applicant.
Under ihe Minnesota Gover.iment Data Practices Act and the Federal Pm'acy Act of 1974, ��e are required to ad�ise you ef the follo�ring
mgarding the use of the Nunnesota TaX Identificatien Number:
- Tbis information may be used to dzny the issua.nce or rene�� al of }`our license in the e� ent ; ou o��.e Minnesota sales, employer s
�.iL�holding or motor � ehicle excise taxes;
- Upon recsiving this information, the licensing aL;hority will supply it only to the :vlinnesota Department of Re�'znue. However,
under the Federal Exchange of In`ormation Agreement, the Departrnent of Revenue may supply tlus infomiation to the Intemal
Revenue Service.
?vfinnesota Tax Identification I�unbeis (Sales & Use TaK Number) may be obtained from the State of Minnesota, Business Records Dep�rtment,
10 Ri��er Park Plaza (612-296-6181). _ - - ..
Sociat Security I�TUmber: �� ��' oZ 0� f�` �7 Minnesota Ta�c Identification Nunber: ����` L U
_ If a Minnesota Tax Identificatioa Number is not required for the business being operated, indicalz so by placing an"X" in lhe box.
� 2/73%97
�lS-Iq`I
c�:�rn=lcario:�� or v,ro.�rRS� cc�;r-LVS,a rio� cov,�z,�cr Pv:z�u.�` r 7 0;�.i:.mZ:soTa s rA7uri: i;�. � sz
I;:e� zby c«tifr il�zt I, or :�:}� eea�p�rv, �m in coaipliance l�iLh u;: �. orl;e: s' con izsura; ce co� erage ; ze:�se�; �e-;s oi'.�.;i- Stz�t? �
1 i6.182, ��h�i�;soz 2. I �c� ur.d�; s:�:;: ;iszt pro��s:oa eT.`z'.:=1=oi�z�on in :}:is ce,'d5ez:ion eor.st;tu:es su��ev:, ; 2:eu�Ls `ar zcce, <z ac6on
gai;ist �il licer,ses heid, i:cha�'±ng rz� ocztie� sd cLSpza:ie� cf sz:d ]icer.ses.
\an;e ci _^srz�ce Coa:pa ;c:
?ci;ry\u*abzr: Cc�er��z`rcm ?o
I Sa��e,,o en:�,ic}ccs cccere3 �_�-cer :��ckz,s' co�:peaszi;ea � ca:a�ce (?\117Ai c)
�:\1' :�hLSIF;C.�TiO'V OF.��SW ERS GFVEi OR :�fATERL4L StiB�fiTTED
��IE,L REStiLT L\ DE!'I,�L OF THIS APrLFCAIFON
I'�ereby stzte thzt I ha�'e �r;s�'.'zred zil of :he preceding que�;�ons, znd Lhat the iafonnatien coatzined herzul is tn�z a:_d cc:Tect to Lhe best ef
*:•y kno�a ledee zr,d belizi. i hereLy state fiu'�hzr thzt I ha� e rzcei� ed no mor.ey or other considerzt±on, by �vzy of lozn, gift, conh er
o��:�; o;her tha� uezdy �sc?os�l iz �he e�plicz+uez �,'r,;ch I he-e;iiLh c�bir�ttd. I�Iso undr, stznd tlus pre*�.ise n be iaspec±ed by po';ce,
£re, heaiLh ar.d other cit�• o:£cizls at �.}' ��d aii t�r.es n hen'h� ous;ness is ;n opzrztion.
7
�. —
(REQUIIZEA?or ztl zppticztions) " IIate
FVe r�'ill accept pa}�ment Uy cash, check (made payable to CiYy of Szint Psut) or credit card (:4LC or Visa).
IF PAYING BY CREBIT CAR13 PLFASE COMPLETE THE FOLLOWING INFORMATION: � MzsterCard � Visa
EXPIRATION DATE: ACCOiJI�Tl' i�'U1ViBER: '
❑o/o❑ ❑oo❑ ❑oo❑ ❑oo❑ ❑oo❑
Cudholder
of Card Holder(required for all
•"Note: If this application is Food/Liquor related, please contect a Ciry of Saint Paul Health Inspector, Steve Olson (266-9139), to re��ew
plans.
If any substantial changes to structwe aze anticipated, please contact a City of Saint Paul PIan Exazniner at 266-9007 to apply for
building pernuts.
Ifthere are an}' changes to the parking lot, floor spzcz, or for new operations, please contact a City of Saint Paul Zoting Inspector at
266-9008.
All apptications require the foIIoning documents. Please attach these documents R�hea submitting }�our application:
]. A detailed description of the design, location znd square footage of the premises to be licensed (site plan).
The follo�i�ing data should be on the site plan (preferably on an 8 12" x 11" or 8 1/2" x I4" paper):
- Name, zddress, and phoae number.
- The scale sbould be stzted such as 1" = 20'. ^N should be indicated to���ard the top.
- Placement of all pertinent features of the interior of the licensed fzcility such as seating azeas, kitchens, off;ces, repair azea,
pzrking, rest rooms, etc.
- If a requcst is for an additioa or expansion of the licensed facility, indicate both the current area and the proposed e�pansion.
2. A copy of your lease aseement or proof of o�3�nership of the property.
SPECIFIC LICENSE AI'PLICATIONS REQiTII2E ADDTTIONAL IlVFOR't�ATION.
PLEASE SEE REVERSE FOR DETAILS >>>>
�Y.'l
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