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98-196ORtGtNAL CITY OF Presented By Referred To Committee: Date RESOLVED: 1 2 3 That application (ID �19970000051) for a Parking Lot/Parking Ramp License(s) by GREAT LAKES REIT INC DBA GREAT LAKES REIT INC at 2550 UNZVERSITY AVE W be and the same is hereby approved. Requested by Department of: Of£ice o£ License, Inspections and Environmental Protection B ��-1�WJ�^�-� f� 1`� Adoption Certified by Council Secretary By: Appx By: RESOLUTION PAUL, MINNESOTA council File# \0 -\� � Ordinance # Green Sheet $ LP60026 y� FoYm A proved by ity Attorney B ��ud � � l�G,( 3•2-g� Approved by Mayor for Submission to Council By: Adopted by Council: Date �� .q_ � DEPARTMENT/OFFICFJCOUNCIL DATE INITUITED q�,� Ct` ( LIEP/Licensitg GREEN SHEET No. LP60026 � ONTACT PERSON & PHONE bmaw� mmavo� LOOM JAMES (JIM) (67�2669073 O CityAflomey UST BE ON COUNGL ACaENDA SY (DAT£} �� 3N7198 �N.3l.�. �?�/�N� NUMBERFOR � CouncaRes�rch ' ROUT@�G OROER TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE� ACTION REQUESTED: Counal apqoral of the fdlaving ficznse appfwation: License # 19970000�1, for GREAT LAKES REI7INC, Doirg Busirress As GREAT LAKES REIT INC, at 2550 UNNERSITY AVE W, inGudirg the fWbwing business type(s): Par{d� LoVParidng Ramp. RECOMMENDATIONS: Approve(A) Reject(R) ERSONAL SERV�CE CON7RACis MU57 ANSWER 7HE FOLLOWING QUES7IONS: 7. Has this perso�rtn ever xrorked under a conVact tw ihis depahment9 PIANNINCa COMMISSION YES NO CIS COMMITTEE 2. Has this personJfmm ever heen a city employee? CIVIL SVC CINN, YES NO . Dces this persoMrtn possess a skili not namaly possessed by arry curtent city employee7 YES NO . Is this persuMcm a targeted rendoR -- YES NO Ezplain all yes answers on xparete sheet ana attach ro green sheet INITIATING PROBLEM, ISSUE, OPPORTUNITY (1Nhp, What, When, Where, Why): Requesting Council approval tx a Parldng lM/Parking Ramp Licertse by Great l.akes REIT I�e. OBA Great Lakes REtT lsu. at 2550 UnivevsiFj Ave. W. ADYANTAGESIFAPPROVED: ISADVANTAGES IF APPROVED: DtSADVANTAGES 4F NOT APPROV£D: TOTAL AMOUNT OF TRANSACTION $ COSLREVENUE 6U�GETEO (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (fXPiAIN) `I�-Iq� CLASS III LICENSE APPLICATION THIS APPLICATION IS SUB7ECT TO REVIEW BY THE PLBLIC PLEASE TYPE OR PRR3T IN��K Parking Lot / 1�m� ��/�j6J) T}pe of License�s) being applied for. CITY OF SAINT PAUL oe;u orL;�, v�.-�� z,a En.iromnr.xat rro,tt.tion 350 nPec s[ S,ere3,ro Sizh:v',YtiaNa 5510'1 (El'<)]669C;0 bs(61�26691:4 J�y�/ k C., �': U.3�' `�G=� - � 317.00 S CompanyNzme: Great Iakes REIT, Inc. corporat;a, artncnh;y � sole AoprinQnhip If buiness is incorporated, give date of incorporation: _ Doing Business As: �� S l' �� Business Address: a�' �.�J11�{L�XS I{Z{ �)(?� �,��l�.�'F� S t�- ��C�tl J sazu aaaR„ c�ry Bem•een what cress streets is the b�siness located? � lstis �-. � irFP,, f Are tbe premises now occupied? Yes What T}pe of Business? = Mail To Address:Great Ialces REIT, Inc �i�� t� Applicant Infonnation: Name and I'itle: Firat S FV '..Sddle (Ma�dra) Rusiness Phone: sr�e zSp Which side of the street7 -.� I.aR Tiilt Home Address: Strxt hddms City State Zip Date of Birth: Place of Birth: Home Phone: i:a:t J.:;. evCC ucZ.:'.::::::�:.:: i V: c:::j .C..:::y', �.II^..�.'v: FIVN:uc'.::::; ::t:)" C:;'j vi:ia:u.:u `v.;:� : :................ ..�- - ..- Date of arrest: Where? Charge: C�nvictic,n: — - - - - Sentenrr_. _ � - List the names �d residences of three petwns of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in ihe premises or business, wno may be refesred to as to the applicanYs chazacter: NAME ADDRESS PHONE List currently bo]d, formerly held, or may have an interest in: Have any of the above named licenses eva been revoked7 YES NO If yes, list the dates and reasons for revocation: 2/18/97 s� naaR,+ c;ry sw{ zsp Are you going to operzte this business �1 U')�1('�.� ' �i �� s�� ' E3oaeAdLress: Strzct\ave Are }�ou gomg to have a mznzeer ot assistant in ttus basiness? please complete the follow�ing i.-iformztioa: Furt \smc Home.4ddrm: St�c-t\ae Ciy Please list your emplo}mrnt history for the pre��ious five (5) } zaz period: Business/Emplo�mrnt -' `-�"--- Address List all other officers of the corporation: OFFICER TITLE i�63� I�TAME , _ (Office Held) ADDRE I.act Statc Zip fi6ic� $USINESS PHONE PHONE Dste Plwn: \usber D ' "' � � If business is a partnenhip, please include the followzne info;�atioa for eac,'�, pxr�� (use additional pages if necessary): Firu \ame A�fiddle Initiil (.4faiden) Las[ , Date of H'vth HomeAddrsse: Siroet::eme ciTy shte Zip Furt':�e ?vfiddleImtisl (.?.4siden) Last DareofBirth xic�e Ad�.: c�Tn- ?:•,,,�. CiTi _ �tntr, Zin MIN2QESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laa•s of Mmnesota, 1984, Chapter 502, Article 8, Section 2(270.72) ('i'ax Cle�ance; Issuance of Licenses), licensing authorities are required to pro��ide to the State of Minnesota Commissioner of Rewenue, the MnnPS�,ta fiuiness tax idenr;fi�^r_on numbzr and *he social securiry munber of each license applicant __ --"-= - — - - - Under the Minnesota Govemment Data Practices Act aad the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification I�TUmber: - Ihis infotmation may be �sed to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this info:mauon, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Ageement, the Departrnent of Revenue may supply tlus information to the Intemal Revenue Sen�ce. Mmnesota Tax Id�tification Numbus (Sales & Use Tax N�ba) may be obtained fiam the State of Minnesota, Business Records Department, 10 Riva Park Plaza (612-296-6181). ' Social Sec�uity Number. Minnesota Tnx Identification Number: JY� �7�T _ If a Minnesoia Tax Identification Number is not required for the business being operated, indicate so by placing an "X' in the box YES �" ?�TO If not, w�ho �xill_ operate it? � (� ��. . `N/�/ � i Ciry YES I,as[ ��a� Dstc Stnte Zip - Phone\umbet NO If the mznager is not the szme as the operator, '.viid�<Initial (.\3aiden) ans�� -I�� CERI"iFICATION OF WORKERS' COMi'ENSATION COVERAGE PURSUANT TO ?�iIiv?QESOTA STANTE 176.182 I hereb} crnif} thzt I, or m� a.:npany, am in compliance w�th the �carke: s' compensation insurance covera2e requirements of Minnesota Statute 176.182, subc',i�ision 2. I zso �derstand Lh2t provision of fase info:matim in this certification cons[itutes �cieat grounds for 2d��erse aclion against all liceases held, includ'uZg recocation and suspension of stid licenses. I�Tune of Insurance �C / fZf C('� /��I'S 4 Policy'�'umber: ( ;� � `7"( � 7 � �"l c� 1.t�1— Coverage from I/ —1 / �O to � � — � _9 � I h2c•e no emplo}'�5 co�'ered tn:der u�c:k`rs comp�sztion i.s` z,ce (IA'IT;ALS) A'rY FAISIFICATION OF ANSWERS GNEN OR?vIATERL4L SUBhiTITED W"R,L RESLZT li1T DEI�TAL OF THIS APPLTCATION I hereby state il;at I hace answ�ered all of the preceding questions, and that the infoTmztion contained herein is hue and cosect to the best of my k�now•ledge and belief: I hereby state further that I have received no money or other consideration, by �ra} of loan, gift, conh or othauise, other thzn zlnady disclosed in the applicaUOn uivch I haeaith submitted I also understand this premise may be inspected b}� police, fire, health and o:.her city officials at any and a11 times w•hen the business is in operation. for all applications) ' Date We tir accept pa}�ment b� cash, cbeck (made payable to Cit}• of Saint Pann or cmdit card (M1C or Visa). IFPAYINGBYCF�DITCA?�JPLE?SECO?!iPLETETHFFOLLOiVINGI.�'FORMATION �?�:as:e!.;�;3 � V:sa EXPIRATION DATE: ACCOL'NT NUMBER: ❑o/o❑ ❑oo❑ ❑oo❑ ❑oo❑ ❑C]o❑ of Cazd Holder(rmuired for all charees) Date *•Note: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to review plans. Lf znv substaatiz chan2es to 1Vucture are anticivated n]ease contsct a Citv of Saint Pael Plan Examiner at 255-9007 te en�Iv for building pecmits. Ifrhere aze any changes to the parldng lot, floor space, or for new operations, please contact a Ciry of Saint Paul Zoning Inspector at 266-9008. � - All application� require the following documents. Please attach these documents w6en submitting your applicatioa: 1. A detailed desciiption of the design, location and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferably on an 8 1/2" x I 1" or 8 12" x 14" paper): - Name, address, and phone number. - Ihe scale should be stated such as 1" = 20'. ^N should be indicated toward the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, o�ces, repair area, parlang, rest rooms, etc. - If a zequest is for an addition or e�cpansion of the licensed facility, indicate both the current area and the proposed eapansion. 2. A copy ofyour lease agreement or proof of ownaship of the property. SPECIFIC LICENSE APPLICATIONS REQUIItE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> 2/18/97 ORtGtNAL CITY OF Presented By Referred To Committee: Date RESOLVED: 1 2 3 That application (ID �19970000051) for a Parking Lot/Parking Ramp License(s) by GREAT LAKES REIT INC DBA GREAT LAKES REIT INC at 2550 UNZVERSITY AVE W be and the same is hereby approved. Requested by Department of: Of£ice o£ License, Inspections and Environmental Protection B ��-1�WJ�^�-� f� 1`� Adoption Certified by Council Secretary By: Appx By: RESOLUTION PAUL, MINNESOTA council File# \0 -\� � Ordinance # Green Sheet $ LP60026 y� FoYm A proved by ity Attorney B ��ud � � l�G,( 3•2-g� Approved by Mayor for Submission to Council By: Adopted by Council: Date �� .q_ � DEPARTMENT/OFFICFJCOUNCIL DATE INITUITED q�,� Ct` ( LIEP/Licensitg GREEN SHEET No. LP60026 � ONTACT PERSON & PHONE bmaw� mmavo� LOOM JAMES (JIM) (67�2669073 O CityAflomey UST BE ON COUNGL ACaENDA SY (DAT£} �� 3N7198 �N.3l.�. �?�/�N� NUMBERFOR � CouncaRes�rch ' ROUT@�G OROER TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE� ACTION REQUESTED: Counal apqoral of the fdlaving ficznse appfwation: License # 19970000�1, for GREAT LAKES REI7INC, Doirg Busirress As GREAT LAKES REIT INC, at 2550 UNNERSITY AVE W, inGudirg the fWbwing business type(s): Par{d� LoVParidng Ramp. RECOMMENDATIONS: Approve(A) Reject(R) ERSONAL SERV�CE CON7RACis MU57 ANSWER 7HE FOLLOWING QUES7IONS: 7. Has this perso�rtn ever xrorked under a conVact tw ihis depahment9 PIANNINCa COMMISSION YES NO CIS COMMITTEE 2. Has this personJfmm ever heen a city employee? CIVIL SVC CINN, YES NO . Dces this persoMrtn possess a skili not namaly possessed by arry curtent city employee7 YES NO . Is this persuMcm a targeted rendoR -- YES NO Ezplain all yes answers on xparete sheet ana attach ro green sheet INITIATING PROBLEM, ISSUE, OPPORTUNITY (1Nhp, What, When, Where, Why): Requesting Council approval tx a Parldng lM/Parking Ramp Licertse by Great l.akes REIT I�e. OBA Great Lakes REtT lsu. at 2550 UnivevsiFj Ave. W. ADYANTAGESIFAPPROVED: ISADVANTAGES IF APPROVED: DtSADVANTAGES 4F NOT APPROV£D: TOTAL AMOUNT OF TRANSACTION $ COSLREVENUE 6U�GETEO (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (fXPiAIN) `I�-Iq� CLASS III LICENSE APPLICATION THIS APPLICATION IS SUB7ECT TO REVIEW BY THE PLBLIC PLEASE TYPE OR PRR3T IN��K Parking Lot / 1�m� ��/�j6J) T}pe of License�s) being applied for. CITY OF SAINT PAUL oe;u orL;�, v�.-�� z,a En.iromnr.xat rro,tt.tion 350 nPec s[ S,ere3,ro Sizh:v',YtiaNa 5510'1 (El'<)]669C;0 bs(61�26691:4 J�y�/ k C., �': U.3�' `�G=� - � 317.00 S CompanyNzme: Great Iakes REIT, Inc. corporat;a, artncnh;y � sole AoprinQnhip If buiness is incorporated, give date of incorporation: _ Doing Business As: �� S l' �� Business Address: a�' �.�J11�{L�XS I{Z{ �)(?� �,��l�.�'F� S t�- ��C�tl J sazu aaaR„ c�ry Bem•een what cress streets is the b�siness located? � lstis �-. � irFP,, f Are tbe premises now occupied? Yes What T}pe of Business? = Mail To Address:Great Ialces REIT, Inc �i�� t� Applicant Infonnation: Name and I'itle: Firat S FV '..Sddle (Ma�dra) Rusiness Phone: sr�e zSp Which side of the street7 -.� I.aR Tiilt Home Address: Strxt hddms City State Zip Date of Birth: Place of Birth: Home Phone: i:a:t J.:;. evCC ucZ.:'.::::::�:.:: i V: c:::j .C..:::y', �.II^..�.'v: FIVN:uc'.::::; ::t:)" C:;'j vi:ia:u.:u `v.;:� : :................ ..�- - ..- Date of arrest: Where? Charge: C�nvictic,n: — - - - - Sentenrr_. _ � - List the names �d residences of three petwns of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in ihe premises or business, wno may be refesred to as to the applicanYs chazacter: NAME ADDRESS PHONE List currently bo]d, formerly held, or may have an interest in: Have any of the above named licenses eva been revoked7 YES NO If yes, list the dates and reasons for revocation: 2/18/97 s� naaR,+ c;ry sw{ zsp Are you going to operzte this business �1 U')�1('�.� ' �i �� s�� ' E3oaeAdLress: Strzct\ave Are }�ou gomg to have a mznzeer ot assistant in ttus basiness? please complete the follow�ing i.-iformztioa: Furt \smc Home.4ddrm: St�c-t\ae Ciy Please list your emplo}mrnt history for the pre��ious five (5) } zaz period: Business/Emplo�mrnt -' `-�"--- Address List all other officers of the corporation: OFFICER TITLE i�63� I�TAME , _ (Office Held) ADDRE I.act Statc Zip fi6ic� $USINESS PHONE PHONE Dste Plwn: \usber D ' "' � � If business is a partnenhip, please include the followzne info;�atioa for eac,'�, pxr�� (use additional pages if necessary): Firu \ame A�fiddle Initiil (.4faiden) Las[ , Date of H'vth HomeAddrsse: Siroet::eme ciTy shte Zip Furt':�e ?vfiddleImtisl (.?.4siden) Last DareofBirth xic�e Ad�.: c�Tn- ?:•,,,�. CiTi _ �tntr, Zin MIN2QESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laa•s of Mmnesota, 1984, Chapter 502, Article 8, Section 2(270.72) ('i'ax Cle�ance; Issuance of Licenses), licensing authorities are required to pro��ide to the State of Minnesota Commissioner of Rewenue, the MnnPS�,ta fiuiness tax idenr;fi�^r_on numbzr and *he social securiry munber of each license applicant __ --"-= - — - - - Under the Minnesota Govemment Data Practices Act aad the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification I�TUmber: - Ihis infotmation may be �sed to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this info:mauon, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Ageement, the Departrnent of Revenue may supply tlus information to the Intemal Revenue Sen�ce. Mmnesota Tax Id�tification Numbus (Sales & Use Tax N�ba) may be obtained fiam the State of Minnesota, Business Records Department, 10 Riva Park Plaza (612-296-6181). ' Social Sec�uity Number. Minnesota Tnx Identification Number: JY� �7�T _ If a Minnesoia Tax Identification Number is not required for the business being operated, indicate so by placing an "X' in the box YES �" ?�TO If not, w�ho �xill_ operate it? � (� ��. . `N/�/ � i Ciry YES I,as[ ��a� Dstc Stnte Zip - Phone\umbet NO If the mznager is not the szme as the operator, '.viid�<Initial (.\3aiden) ans�� -I�� CERI"iFICATION OF WORKERS' COMi'ENSATION COVERAGE PURSUANT TO ?�iIiv?QESOTA STANTE 176.182 I hereb} crnif} thzt I, or m� a.:npany, am in compliance w�th the �carke: s' compensation insurance covera2e requirements of Minnesota Statute 176.182, subc',i�ision 2. I zso �derstand Lh2t provision of fase info:matim in this certification cons[itutes �cieat grounds for 2d��erse aclion against all liceases held, includ'uZg recocation and suspension of stid licenses. I�Tune of Insurance �C / fZf C('� /��I'S 4 Policy'�'umber: ( ;� � `7"( � 7 � �"l c� 1.t�1— Coverage from I/ —1 / �O to � � — � _9 � I h2c•e no emplo}'�5 co�'ered tn:der u�c:k`rs comp�sztion i.s` z,ce (IA'IT;ALS) A'rY FAISIFICATION OF ANSWERS GNEN OR?vIATERL4L SUBhiTITED W"R,L RESLZT li1T DEI�TAL OF THIS APPLTCATION I hereby state il;at I hace answ�ered all of the preceding questions, and that the infoTmztion contained herein is hue and cosect to the best of my k�now•ledge and belief: I hereby state further that I have received no money or other consideration, by �ra} of loan, gift, conh or othauise, other thzn zlnady disclosed in the applicaUOn uivch I haeaith submitted I also understand this premise may be inspected b}� police, fire, health and o:.her city officials at any and a11 times w•hen the business is in operation. for all applications) ' Date We tir accept pa}�ment b� cash, cbeck (made payable to Cit}• of Saint Pann or cmdit card (M1C or Visa). IFPAYINGBYCF�DITCA?�JPLE?SECO?!iPLETETHFFOLLOiVINGI.�'FORMATION �?�:as:e!.;�;3 � V:sa EXPIRATION DATE: ACCOL'NT NUMBER: ❑o/o❑ ❑oo❑ ❑oo❑ ❑oo❑ ❑C]o❑ of Cazd Holder(rmuired for all charees) Date *•Note: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to review plans. Lf znv substaatiz chan2es to 1Vucture are anticivated n]ease contsct a Citv of Saint Pael Plan Examiner at 255-9007 te en�Iv for building pecmits. Ifrhere aze any changes to the parldng lot, floor space, or for new operations, please contact a Ciry of Saint Paul Zoning Inspector at 266-9008. � - All application� require the following documents. Please attach these documents w6en submitting your applicatioa: 1. A detailed desciiption of the design, location and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferably on an 8 1/2" x I 1" or 8 12" x 14" paper): - Name, address, and phone number. - Ihe scale should be stated such as 1" = 20'. ^N should be indicated toward the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, o�ces, repair area, parlang, rest rooms, etc. - If a zequest is for an addition or e�cpansion of the licensed facility, indicate both the current area and the proposed eapansion. 2. A copy ofyour lease agreement or proof of ownaship of the property. SPECIFIC LICENSE APPLICATIONS REQUIItE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> 2/18/97 ORtGtNAL CITY OF Presented By Referred To Committee: Date RESOLVED: 1 2 3 That application (ID �19970000051) for a Parking Lot/Parking Ramp License(s) by GREAT LAKES REIT INC DBA GREAT LAKES REIT INC at 2550 UNZVERSITY AVE W be and the same is hereby approved. Requested by Department of: Of£ice o£ License, Inspections and Environmental Protection B ��-1�WJ�^�-� f� 1`� Adoption Certified by Council Secretary By: Appx By: RESOLUTION PAUL, MINNESOTA council File# \0 -\� � Ordinance # Green Sheet $ LP60026 y� FoYm A proved by ity Attorney B ��ud � � l�G,( 3•2-g� Approved by Mayor for Submission to Council By: Adopted by Council: Date �� .q_ � DEPARTMENT/OFFICFJCOUNCIL DATE INITUITED q�,� Ct` ( LIEP/Licensitg GREEN SHEET No. LP60026 � ONTACT PERSON & PHONE bmaw� mmavo� LOOM JAMES (JIM) (67�2669073 O CityAflomey UST BE ON COUNGL ACaENDA SY (DAT£} �� 3N7198 �N.3l.�. �?�/�N� NUMBERFOR � CouncaRes�rch ' ROUT@�G OROER TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE� ACTION REQUESTED: Counal apqoral of the fdlaving ficznse appfwation: License # 19970000�1, for GREAT LAKES REI7INC, Doirg Busirress As GREAT LAKES REIT INC, at 2550 UNNERSITY AVE W, inGudirg the fWbwing business type(s): Par{d� LoVParidng Ramp. RECOMMENDATIONS: Approve(A) Reject(R) ERSONAL SERV�CE CON7RACis MU57 ANSWER 7HE FOLLOWING QUES7IONS: 7. Has this perso�rtn ever xrorked under a conVact tw ihis depahment9 PIANNINCa COMMISSION YES NO CIS COMMITTEE 2. Has this personJfmm ever heen a city employee? CIVIL SVC CINN, YES NO . Dces this persoMrtn possess a skili not namaly possessed by arry curtent city employee7 YES NO . Is this persuMcm a targeted rendoR -- YES NO Ezplain all yes answers on xparete sheet ana attach ro green sheet INITIATING PROBLEM, ISSUE, OPPORTUNITY (1Nhp, What, When, Where, Why): Requesting Council approval tx a Parldng lM/Parking Ramp Licertse by Great l.akes REIT I�e. OBA Great Lakes REtT lsu. at 2550 UnivevsiFj Ave. W. ADYANTAGESIFAPPROVED: ISADVANTAGES IF APPROVED: DtSADVANTAGES 4F NOT APPROV£D: TOTAL AMOUNT OF TRANSACTION $ COSLREVENUE 6U�GETEO (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (fXPiAIN) `I�-Iq� CLASS III LICENSE APPLICATION THIS APPLICATION IS SUB7ECT TO REVIEW BY THE PLBLIC PLEASE TYPE OR PRR3T IN��K Parking Lot / 1�m� ��/�j6J) T}pe of License�s) being applied for. CITY OF SAINT PAUL oe;u orL;�, v�.-�� z,a En.iromnr.xat rro,tt.tion 350 nPec s[ S,ere3,ro Sizh:v',YtiaNa 5510'1 (El'<)]669C;0 bs(61�26691:4 J�y�/ k C., �': U.3�' `�G=� - � 317.00 S CompanyNzme: Great Iakes REIT, Inc. corporat;a, artncnh;y � sole AoprinQnhip If buiness is incorporated, give date of incorporation: _ Doing Business As: �� S l' �� Business Address: a�' �.�J11�{L�XS I{Z{ �)(?� �,��l�.�'F� S t�- ��C�tl J sazu aaaR„ c�ry Bem•een what cress streets is the b�siness located? � lstis �-. � irFP,, f Are tbe premises now occupied? Yes What T}pe of Business? = Mail To Address:Great Ialces REIT, Inc �i�� t� Applicant Infonnation: Name and I'itle: Firat S FV '..Sddle (Ma�dra) Rusiness Phone: sr�e zSp Which side of the street7 -.� I.aR Tiilt Home Address: Strxt hddms City State Zip Date of Birth: Place of Birth: Home Phone: i:a:t J.:;. evCC ucZ.:'.::::::�:.:: i V: c:::j .C..:::y', �.II^..�.'v: FIVN:uc'.::::; ::t:)" C:;'j vi:ia:u.:u `v.;:� : :................ ..�- - ..- Date of arrest: Where? Charge: C�nvictic,n: — - - - - Sentenrr_. _ � - List the names �d residences of three petwns of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financially interested in ihe premises or business, wno may be refesred to as to the applicanYs chazacter: NAME ADDRESS PHONE List currently bo]d, formerly held, or may have an interest in: Have any of the above named licenses eva been revoked7 YES NO If yes, list the dates and reasons for revocation: 2/18/97 s� naaR,+ c;ry sw{ zsp Are you going to operzte this business �1 U')�1('�.� ' �i �� s�� ' E3oaeAdLress: Strzct\ave Are }�ou gomg to have a mznzeer ot assistant in ttus basiness? please complete the follow�ing i.-iformztioa: Furt \smc Home.4ddrm: St�c-t\ae Ciy Please list your emplo}mrnt history for the pre��ious five (5) } zaz period: Business/Emplo�mrnt -' `-�"--- Address List all other officers of the corporation: OFFICER TITLE i�63� I�TAME , _ (Office Held) ADDRE I.act Statc Zip fi6ic� $USINESS PHONE PHONE Dste Plwn: \usber D ' "' � � If business is a partnenhip, please include the followzne info;�atioa for eac,'�, pxr�� (use additional pages if necessary): Firu \ame A�fiddle Initiil (.4faiden) Las[ , Date of H'vth HomeAddrsse: Siroet::eme ciTy shte Zip Furt':�e ?vfiddleImtisl (.?.4siden) Last DareofBirth xic�e Ad�.: c�Tn- ?:•,,,�. CiTi _ �tntr, Zin MIN2QESOTA TAX IDENTIFICATION NUMBER - Pursuant to the Laa•s of Mmnesota, 1984, Chapter 502, Article 8, Section 2(270.72) ('i'ax Cle�ance; Issuance of Licenses), licensing authorities are required to pro��ide to the State of Minnesota Commissioner of Rewenue, the MnnPS�,ta fiuiness tax idenr;fi�^r_on numbzr and *he social securiry munber of each license applicant __ --"-= - — - - - Under the Minnesota Govemment Data Practices Act aad the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification I�TUmber: - Ihis infotmation may be �sed to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withholding or motor vehicle excise taxes; - Upon receiving this info:mauon, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Ageement, the Departrnent of Revenue may supply tlus information to the Intemal Revenue Sen�ce. Mmnesota Tax Id�tification Numbus (Sales & Use Tax N�ba) may be obtained fiam the State of Minnesota, Business Records Department, 10 Riva Park Plaza (612-296-6181). ' Social Sec�uity Number. Minnesota Tnx Identification Number: JY� �7�T _ If a Minnesoia Tax Identification Number is not required for the business being operated, indicate so by placing an "X' in the box YES �" ?�TO If not, w�ho �xill_ operate it? � (� ��. . `N/�/ � i Ciry YES I,as[ ��a� Dstc Stnte Zip - Phone\umbet NO If the mznager is not the szme as the operator, '.viid�<Initial (.\3aiden) ans�� -I�� CERI"iFICATION OF WORKERS' COMi'ENSATION COVERAGE PURSUANT TO ?�iIiv?QESOTA STANTE 176.182 I hereb} crnif} thzt I, or m� a.:npany, am in compliance w�th the �carke: s' compensation insurance covera2e requirements of Minnesota Statute 176.182, subc',i�ision 2. I zso �derstand Lh2t provision of fase info:matim in this certification cons[itutes �cieat grounds for 2d��erse aclion against all liceases held, includ'uZg recocation and suspension of stid licenses. I�Tune of Insurance �C / fZf C('� /��I'S 4 Policy'�'umber: ( ;� � `7"( � 7 � �"l c� 1.t�1— Coverage from I/ —1 / �O to � � — � _9 � I h2c•e no emplo}'�5 co�'ered tn:der u�c:k`rs comp�sztion i.s` z,ce (IA'IT;ALS) A'rY FAISIFICATION OF ANSWERS GNEN OR?vIATERL4L SUBhiTITED W"R,L RESLZT li1T DEI�TAL OF THIS APPLTCATION I hereby state il;at I hace answ�ered all of the preceding questions, and that the infoTmztion contained herein is hue and cosect to the best of my k�now•ledge and belief: I hereby state further that I have received no money or other consideration, by �ra} of loan, gift, conh or othauise, other thzn zlnady disclosed in the applicaUOn uivch I haeaith submitted I also understand this premise may be inspected b}� police, fire, health and o:.her city officials at any and a11 times w•hen the business is in operation. for all applications) ' Date We tir accept pa}�ment b� cash, cbeck (made payable to Cit}• of Saint Pann or cmdit card (M1C or Visa). IFPAYINGBYCF�DITCA?�JPLE?SECO?!iPLETETHFFOLLOiVINGI.�'FORMATION �?�:as:e!.;�;3 � V:sa EXPIRATION DATE: ACCOL'NT NUMBER: ❑o/o❑ ❑oo❑ ❑oo❑ ❑oo❑ ❑C]o❑ of Cazd Holder(rmuired for all charees) Date *•Note: If this application is Food/Liquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to review plans. Lf znv substaatiz chan2es to 1Vucture are anticivated n]ease contsct a Citv of Saint Pael Plan Examiner at 255-9007 te en�Iv for building pecmits. Ifrhere aze any changes to the parldng lot, floor space, or for new operations, please contact a Ciry of Saint Paul Zoning Inspector at 266-9008. � - All application� require the following documents. Please attach these documents w6en submitting your applicatioa: 1. A detailed desciiption of the design, location and square footage of the premises to be licensed (site plan). The following data should be on the site plan (preferably on an 8 1/2" x I 1" or 8 12" x 14" paper): - Name, address, and phone number. - Ihe scale should be stated such as 1" = 20'. ^N should be indicated toward the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, o�ces, repair area, parlang, rest rooms, etc. - If a zequest is for an addition or e�cpansion of the licensed facility, indicate both the current area and the proposed eapansion. 2. A copy ofyour lease agreement or proof of ownaship of the property. SPECIFIC LICENSE APPLICATIONS REQUIItE ADDTTIONAL INFORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> 2/18/97