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98-278Council File# 9 g- s�t8 ordinance # O�i��i�. Presented By Referred To �, / CITY OF SAfNT PAUL, MINNESOTA RESOLUTION �� ,G� Committee: Date ✓� RESOLVED: 1 That application (ID �19980000007) for a Restaurant (B) - more 2 than 12 seats, Malt Off Sale, Liquor On Sale - Sunday, Liquor 3 On Sale - 100 seata or lesa (C), Gambling Location (Class A) 4 License(s) by T J BELLS DBA T J BELLS at 1201 JACKSON ST be and 5 the same is hereby approved. Requested by Department of: Office of License, inapections and Environmental Protection (��.,�,�:.� � �� By: `� � Form Approved by City Attorney� By: ApF By: By: Approved by Maypr for Submission to Council By: Green Sheet # LP60030 Adopted by Council: Date _,� ` $, 1`��lY Adoption Certified by Council Secretary DEPARTMENT/OFFICE/CWNCIL Oa7EiNl'itAiED LfEP/Lice�sirg GREEN SHEET No. LP60030 q$' ��F ONTACT PERSON & PHONE „�� .�� IO�M JAMES {Jl►q �s'2y�ss°r3 � c�yaa�r UST BE ON CAUNCIL AGENDA BY (DATE) � 'v� M�i�01! Q CamW Research ROHTtfG ORL�2 TOTAL# OF SIGNANRE PAGES (CUP ALL LOCATIONS FOR SIGNATUR� ACTION REQUES7ED: Cwnc� appraval of the idbwi�g Gcerise appi'�cation: Lice�e # 79980000D07, for T J BELLS, Doing Business As T J BELLS, � 1201 JACKSON ST, u�cludi�9 the foilorring Wsiness type(s): Resmu2M (6) - rtare Man 12 s�ts, A�latt Otf Sa�� li9uor On Sale - SundaY. liQuor On Sale -100 s�5 or less (C), Gamblinp Lacation (Cfaa A). RECOMMENDATIONS: Approve(A) Reject(R) RSONAL SERVICE CANTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: 1. Hes fhis DersoNfirtn ever wotked under a contract �r this depaNmeM? PLANNING COMMiSStON YES NO CIB COMMITTEE 2. Has this persoMrm ever heen e dy employee? CML SVC CINN, �'ES NO a. Does tnis persoMfi�m v� a sbn nw norma�N oossessed Dr amr currem cAy emo�oyee9 YES NO . kihisperswVfirmahrgetedvendoR YES NO FxpW(n all yes answen on aeparrte sheet antl attach to green aheet INITIATING PROBLEM, ISSUE, OPPOR7UNITY (Who, What, When, Where, Why): Requesting Couxil apprcval for T. J, 8elfs DBA 7.J. Bells iw L'puor OrrSale (CJ, Sunday On-Sale liquor, Resmurant (B), OffSale Meft, Gambling Laeation (C) Licenses at 1201 Jackson St. ADVANTAGES IF APPROVED: �O`QUSBCIE RQSiO�'C4? CF°tfB� �aR s, �. �s� ISADVANTAGES IF APPROVED: -.-. ___._._..,...,-,..�....��....�. .,. �. — -_. �..._._+ ISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLf ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAINj CLASS III LICENSE APPLICATION THIS APPLICAI'IO'd IS SUB7ECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT L�3 INK I'}pe of Licer.se(s) being applied for: �� CffY OF SAIidT PAL�L OL:ce of Licr.�se, L�s�a^lio;s 2nd Emiron:te�izl Pre:ection 3w scPr.a sc S,:.e 3� Si,-tt?a:il,.Y_:-��o•a 5'IC2 (6II)165-_W9� frzI613)3E5-91.4 S �Jf'f� S l�C (z Yvi Y� Company :� z,-nz; Corporaion / Psttne+ship i Sole Arop:ietoss6ip If business is incorporated, �ve date of incorporalion: _ Doing Busine5s As: �a� �t' ��S Business Address: �2�7 � � rl ( �S L� su�e nad,�, °' Between �•hat cross s�eets is the business loczted? < f V Are the preirases norc oxupied7 �� V11:at T}pe of Business? Mail To Address: Applicant Name and Home Adc CiN State Zip Wfiich side of the street? � W Date of Birth: _ f�� 7 P1ace of Birxh: �iR lfi�l �, Y l��ln Home Phone: ,�j rS �'c� �� Have you ever beea coni�cied of any felony, crime or ��iolation of any city ordinance other tkian traffic? YES NO � Date of azrest: Where? Charge: Conviction Sentence: List the names 2nd residences of three persons of good moral character, living within the Twin Cities IvTeuo Area, not related to the apglicant or financially interested in ihe premises or business, w�ho may be refe:red to as to the applicaaYs chazacter: Have any of tl�e above named licenses ever been revoked? � PHONE YES NO If yes, list the dates and reasons for revocation: 2/18/97 se«c na�,. c;�y s� Up List licenses which you curm�tly Lold, fotmerly bel� ot may have an inzerest in: -- Are you going to operate this 6usiness personall}'? � YES Firs[ \me FIomeAddraa: Stxcec`:ama Vfiddic Ltitiel I�TO If not, �rho will operate it? q� "�� I (\leiden) Last DaleofBirth Cih' � � Sizte Zip Plime\�ber YES �\O If the Ln��eger is not ��e sd as the operato;, A;e }'ou goir.g to hz��e a�z�E� or zssizzt ia t�s hnsv�ess? ple2se completz the ioilo��ing info..n2tioa: �iti� Homc 4ddras: Sfrxct\�c City I.ast Sffite Zip Deu of Binh Phone \imbet Please list }�our emplo}�nent history for the preti�ious fice (�) } eaz period: _.._ . — . ----. , ... �fldiess �'= - ':- -. -:,-.�,._:w-_,,.a�. ,�_..�.,--. _._-.,.,-..., _ ,._.. . .. __ _,... _._� _, __- - � /inn�/J �l/� Uld ��+ Y��L�c� C��ti"�1n ��. �l�-�/IL List all othet officers ofthe corporation: OFFICER TITLE HO?v7E NAME , (Office Held) ADDRESS HOME BUSI2�TESS DATE OF PHOI�TE PHONE BIRTH If business is a partnership, please inciude the following infonnation for each pa�tner (use additional pages if necessary): Fuat\'sme M�dAelnitiel (.'vteiden) Lasc DateafBirt2� SireciNamo City State � Zip PhoaeI3umber Fuat:Came bLddteInitiat (,Msidrn) Las[ DateofHirtt� Home Addtns: Strat Nsme City Stste Zip Phone \�ber MINNESOTA TAX IDEN'IIFICATION 13UNBER - Pursuant to the I,aws of Minnesota, 1984, Chapter 502, luticle 8, Seclion 2(270.72) (Tax Clearance�, Issuance of Licenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax identification number and the social security number of each license applicaat Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we ue required to advise you of the following reguding the use of the Minnesota Taac Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe M'uuiesoffi sales, employer's w�ithholding or motor velucle e�ccise taxes; - Upon receiving this infarmation, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Eachange of InfoRnation Agreement, the Department of Revrnue may supply this info:mation to the Intemai Revenue Service. Ivfiffie�nta Tax Identificarion Numbe� {Sales & Use Ta� Number) may be obtained from the State of Minnesota, Business Records Depar�ent, 10 RiverPark Plaza (612-296-6181). . Sacial Security Number: �7� —�i�' �� 7 � Minnesots Tax Identification Number: 1f a Minnesofa Tsx IdentiScation Nwnber is not required for the business being operated, indicate so by placing an "X" in the box ! �� ` vis�� -a�� CERTIFICATION OF WORKERS' CONPENSATION COVERAGE PURSUANT TO MINNESOTA STATUTE 176.182 I hereby c�rtify that I, or m}• company, azn in compliance uith the k'orkas' compensation insurance cocerage requiremrnts of Minnesota Statuie 1 i6.182, ssbdi�ision 2. I 21so undzrs.and that pro��ision offalc i*�fotmation in this certification constitutes s�cient govnds for ad�•erse action against all licenses held, incJuding rerocation and suspension of said licenses. ;�Tazne of?nswance Company: ��E' �r.tm(� / U� i.�� Policy2�Tumber: Covera¢efrom to I ha��e no emplo} ees cocered under �rorkers' compensatioa i.suranrz (II�ZTIALS) ANY FALSIFICATION OF A.\SWERS GIVEN OR MATERIt1L SUB�IITTED WIId, RESULT L1` DE\�L OF THIS APPLICATION I hereby stafe that I have answered all of the preceding questions, xnd that the infom�ation contained herein is hve and rarrect to tfie best of ,.<<'- .-_ my Ymou•ledge asrd beIief. I hereby state fwtliei ihat'i hace ieceived no money or ather conside"rauon, Ty u=ay of loan, gift; contribulion, or othernix, other than 21�eadp disclos,.d in the applicaIIOn which I ha�ith submined I also understa.nd this premise may be inspected hy police, fire, heaLh azd other city officizls at any and all ti�nes when the business is in operato�. FF'e nill accept pa� ment 6,� cash, check (mxde Fz} abSe ta CitF of Caint Paull �r er_dit =ar3 (iZ�C ot Visz). IFPAYINGBYCKE'DITGiRDPLEASECOMPLETETHEFOI,LOH'INGINFORMATION: �MasterCard �Visa EXPII2ATION DATE: ACCOUNT NUMBER: ' G�7�7/�� C7Ca7�� i�� 10� �rc�-n � . ��r�-( \arne of Car�oldu (alease vzint) •"Note: If this application is FoodQ.iquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re�riew plans. If any substanfial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-900'7 to apply for building pe;mits. If there are any ch�ges to the parking loi, floor space, or for new operations, piease contact a City of Saint Paul Zoning Inspector at 266-9008. All app6cations require the following documents. Please attach tHese documents n•Len submitting your applicatioa: 1. A detailed description of tfie design, locaGon and square footage of the premises to be licen.�esl (site plan). The following data should be on the site plan (prefetably on an 8 ll2" x I 1" or 8 1/2" x 14" paper): - Name, atidress, and phone numbet. - The scale should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placemeni of all pertineat features of the interior of the licensed facility such as seating areas, kitcLens, offices, repair atea, parking, rest rooms, ete. - - ffa request is for an addition or eapansion of the licensed faciiity, indicate both the current azea and the proposed e�.pansioa 2. A copy ofyour lease agrzemeat or proof of ownership of the property. SPECIFIC LICENSE APPLICA3TONS REQUIRE ADDTTIONAL IlVFORMATION. PLEASE SEE REVERSE FOR DETAII,S>»> �' ansrv� Council File# 9 g- s�t8 ordinance # O�i��i�. Presented By Referred To �, / CITY OF SAfNT PAUL, MINNESOTA RESOLUTION �� ,G� Committee: Date ✓� RESOLVED: 1 That application (ID �19980000007) for a Restaurant (B) - more 2 than 12 seats, Malt Off Sale, Liquor On Sale - Sunday, Liquor 3 On Sale - 100 seata or lesa (C), Gambling Location (Class A) 4 License(s) by T J BELLS DBA T J BELLS at 1201 JACKSON ST be and 5 the same is hereby approved. Requested by Department of: Office of License, inapections and Environmental Protection (��.,�,�:.� � �� By: `� � Form Approved by City Attorney� By: ApF By: By: Approved by Maypr for Submission to Council By: Green Sheet # LP60030 Adopted by Council: Date _,� ` $, 1`��lY Adoption Certified by Council Secretary DEPARTMENT/OFFICE/CWNCIL Oa7EiNl'itAiED LfEP/Lice�sirg GREEN SHEET No. LP60030 q$' ��F ONTACT PERSON & PHONE „�� .�� IO�M JAMES {Jl►q �s'2y�ss°r3 � c�yaa�r UST BE ON CAUNCIL AGENDA BY (DATE) � 'v� M�i�01! Q CamW Research ROHTtfG ORL�2 TOTAL# OF SIGNANRE PAGES (CUP ALL LOCATIONS FOR SIGNATUR� ACTION REQUES7ED: Cwnc� appraval of the idbwi�g Gcerise appi'�cation: Lice�e # 79980000D07, for T J BELLS, Doing Business As T J BELLS, � 1201 JACKSON ST, u�cludi�9 the foilorring Wsiness type(s): Resmu2M (6) - rtare Man 12 s�ts, A�latt Otf Sa�� li9uor On Sale - SundaY. liQuor On Sale -100 s�5 or less (C), Gamblinp Lacation (Cfaa A). RECOMMENDATIONS: Approve(A) Reject(R) RSONAL SERVICE CANTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: 1. Hes fhis DersoNfirtn ever wotked under a contract �r this depaNmeM? PLANNING COMMiSStON YES NO CIB COMMITTEE 2. Has this persoMrm ever heen e dy employee? CML SVC CINN, �'ES NO a. Does tnis persoMfi�m v� a sbn nw norma�N oossessed Dr amr currem cAy emo�oyee9 YES NO . kihisperswVfirmahrgetedvendoR YES NO FxpW(n all yes answen on aeparrte sheet antl attach to green aheet INITIATING PROBLEM, ISSUE, OPPOR7UNITY (Who, What, When, Where, Why): Requesting Couxil apprcval for T. J, 8elfs DBA 7.J. Bells iw L'puor OrrSale (CJ, Sunday On-Sale liquor, Resmurant (B), OffSale Meft, Gambling Laeation (C) Licenses at 1201 Jackson St. ADVANTAGES IF APPROVED: �O`QUSBCIE RQSiO�'C4? CF°tfB� �aR s, �. �s� ISADVANTAGES IF APPROVED: -.-. ___._._..,...,-,..�....��....�. .,. �. — -_. �..._._+ ISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLf ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAINj CLASS III LICENSE APPLICATION THIS APPLICAI'IO'd IS SUB7ECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT L�3 INK I'}pe of Licer.se(s) being applied for: �� CffY OF SAIidT PAL�L OL:ce of Licr.�se, L�s�a^lio;s 2nd Emiron:te�izl Pre:ection 3w scPr.a sc S,:.e 3� Si,-tt?a:il,.Y_:-��o•a 5'IC2 (6II)165-_W9� frzI613)3E5-91.4 S �Jf'f� S l�C (z Yvi Y� Company :� z,-nz; Corporaion / Psttne+ship i Sole Arop:ietoss6ip If business is incorporated, �ve date of incorporalion: _ Doing Busine5s As: �a� �t' ��S Business Address: �2�7 � � rl ( �S L� su�e nad,�, °' Between �•hat cross s�eets is the business loczted? < f V Are the preirases norc oxupied7 �� V11:at T}pe of Business? Mail To Address: Applicant Name and Home Adc CiN State Zip Wfiich side of the street? � W Date of Birth: _ f�� 7 P1ace of Birxh: �iR lfi�l �, Y l��ln Home Phone: ,�j rS �'c� �� Have you ever beea coni�cied of any felony, crime or ��iolation of any city ordinance other tkian traffic? YES NO � Date of azrest: Where? Charge: Conviction Sentence: List the names 2nd residences of three persons of good moral character, living within the Twin Cities IvTeuo Area, not related to the apglicant or financially interested in ihe premises or business, w�ho may be refe:red to as to the applicaaYs chazacter: Have any of tl�e above named licenses ever been revoked? � PHONE YES NO If yes, list the dates and reasons for revocation: 2/18/97 se«c na�,. c;�y s� Up List licenses which you curm�tly Lold, fotmerly bel� ot may have an inzerest in: -- Are you going to operate this 6usiness personall}'? � YES Firs[ \me FIomeAddraa: Stxcec`:ama Vfiddic Ltitiel I�TO If not, �rho will operate it? q� "�� I (\leiden) Last DaleofBirth Cih' � � Sizte Zip Plime\�ber YES �\O If the Ln��eger is not ��e sd as the operato;, A;e }'ou goir.g to hz��e a�z�E� or zssizzt ia t�s hnsv�ess? ple2se completz the ioilo��ing info..n2tioa: �iti� Homc 4ddras: Sfrxct\�c City I.ast Sffite Zip Deu of Binh Phone \imbet Please list }�our emplo}�nent history for the preti�ious fice (�) } eaz period: _.._ . — . ----. , ... �fldiess �'= - ':- -. -:,-.�,._:w-_,,.a�. ,�_..�.,--. _._-.,.,-..., _ ,._.. . .. __ _,... _._� _, __- - � /inn�/J �l/� Uld ��+ Y��L�c� C��ti"�1n ��. �l�-�/IL List all othet officers ofthe corporation: OFFICER TITLE HO?v7E NAME , (Office Held) ADDRESS HOME BUSI2�TESS DATE OF PHOI�TE PHONE BIRTH If business is a partnership, please inciude the following infonnation for each pa�tner (use additional pages if necessary): Fuat\'sme M�dAelnitiel (.'vteiden) Lasc DateafBirt2� SireciNamo City State � Zip PhoaeI3umber Fuat:Came bLddteInitiat (,Msidrn) Las[ DateofHirtt� Home Addtns: Strat Nsme City Stste Zip Phone \�ber MINNESOTA TAX IDEN'IIFICATION 13UNBER - Pursuant to the I,aws of Minnesota, 1984, Chapter 502, luticle 8, Seclion 2(270.72) (Tax Clearance�, Issuance of Licenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax identification number and the social security number of each license applicaat Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we ue required to advise you of the following reguding the use of the Minnesota Taac Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe M'uuiesoffi sales, employer's w�ithholding or motor velucle e�ccise taxes; - Upon receiving this infarmation, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Eachange of InfoRnation Agreement, the Department of Revrnue may supply this info:mation to the Intemai Revenue Service. Ivfiffie�nta Tax Identificarion Numbe� {Sales & Use Ta� Number) may be obtained from the State of Minnesota, Business Records Depar�ent, 10 RiverPark Plaza (612-296-6181). . Sacial Security Number: �7� —�i�' �� 7 � Minnesots Tax Identification Number: 1f a Minnesofa Tsx IdentiScation Nwnber is not required for the business being operated, indicate so by placing an "X" in the box ! �� ` vis�� -a�� CERTIFICATION OF WORKERS' CONPENSATION COVERAGE PURSUANT TO MINNESOTA STATUTE 176.182 I hereby c�rtify that I, or m}• company, azn in compliance uith the k'orkas' compensation insurance cocerage requiremrnts of Minnesota Statuie 1 i6.182, ssbdi�ision 2. I 21so undzrs.and that pro��ision offalc i*�fotmation in this certification constitutes s�cient govnds for ad�•erse action against all licenses held, incJuding rerocation and suspension of said licenses. ;�Tazne of?nswance Company: ��E' �r.tm(� / U� i.�� Policy2�Tumber: Covera¢efrom to I ha��e no emplo} ees cocered under �rorkers' compensatioa i.suranrz (II�ZTIALS) ANY FALSIFICATION OF A.\SWERS GIVEN OR MATERIt1L SUB�IITTED WIId, RESULT L1` DE\�L OF THIS APPLICATION I hereby stafe that I have answered all of the preceding questions, xnd that the infom�ation contained herein is hve and rarrect to tfie best of ,.<<'- .-_ my Ymou•ledge asrd beIief. I hereby state fwtliei ihat'i hace ieceived no money or ather conside"rauon, Ty u=ay of loan, gift; contribulion, or othernix, other than 21�eadp disclos,.d in the applicaIIOn which I ha�ith submined I also understa.nd this premise may be inspected hy police, fire, heaLh azd other city officizls at any and all ti�nes when the business is in operato�. FF'e nill accept pa� ment 6,� cash, check (mxde Fz} abSe ta CitF of Caint Paull �r er_dit =ar3 (iZ�C ot Visz). IFPAYINGBYCKE'DITGiRDPLEASECOMPLETETHEFOI,LOH'INGINFORMATION: �MasterCard �Visa EXPII2ATION DATE: ACCOUNT NUMBER: ' G�7�7/�� C7Ca7�� i�� 10� �rc�-n � . ��r�-( \arne of Car�oldu (alease vzint) •"Note: If this application is FoodQ.iquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re�riew plans. If any substanfial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-900'7 to apply for building pe;mits. If there are any ch�ges to the parking loi, floor space, or for new operations, piease contact a City of Saint Paul Zoning Inspector at 266-9008. All app6cations require the following documents. Please attach tHese documents n•Len submitting your applicatioa: 1. A detailed description of tfie design, locaGon and square footage of the premises to be licen.�esl (site plan). The following data should be on the site plan (prefetably on an 8 ll2" x I 1" or 8 1/2" x 14" paper): - Name, atidress, and phone numbet. - The scale should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placemeni of all pertineat features of the interior of the licensed facility such as seating areas, kitcLens, offices, repair atea, parking, rest rooms, ete. - - ffa request is for an addition or eapansion of the licensed faciiity, indicate both the current azea and the proposed e�.pansioa 2. A copy ofyour lease agrzemeat or proof of ownership of the property. SPECIFIC LICENSE APPLICA3TONS REQUIRE ADDTTIONAL IlVFORMATION. PLEASE SEE REVERSE FOR DETAII,S>»> �' ansrv� Council File# 9 g- s�t8 ordinance # O�i��i�. Presented By Referred To �, / CITY OF SAfNT PAUL, MINNESOTA RESOLUTION �� ,G� Committee: Date ✓� RESOLVED: 1 That application (ID �19980000007) for a Restaurant (B) - more 2 than 12 seats, Malt Off Sale, Liquor On Sale - Sunday, Liquor 3 On Sale - 100 seata or lesa (C), Gambling Location (Class A) 4 License(s) by T J BELLS DBA T J BELLS at 1201 JACKSON ST be and 5 the same is hereby approved. Requested by Department of: Office of License, inapections and Environmental Protection (��.,�,�:.� � �� By: `� � Form Approved by City Attorney� By: ApF By: By: Approved by Maypr for Submission to Council By: Green Sheet # LP60030 Adopted by Council: Date _,� ` $, 1`��lY Adoption Certified by Council Secretary DEPARTMENT/OFFICE/CWNCIL Oa7EiNl'itAiED LfEP/Lice�sirg GREEN SHEET No. LP60030 q$' ��F ONTACT PERSON & PHONE „�� .�� IO�M JAMES {Jl►q �s'2y�ss°r3 � c�yaa�r UST BE ON CAUNCIL AGENDA BY (DATE) � 'v� M�i�01! Q CamW Research ROHTtfG ORL�2 TOTAL# OF SIGNANRE PAGES (CUP ALL LOCATIONS FOR SIGNATUR� ACTION REQUES7ED: Cwnc� appraval of the idbwi�g Gcerise appi'�cation: Lice�e # 79980000D07, for T J BELLS, Doing Business As T J BELLS, � 1201 JACKSON ST, u�cludi�9 the foilorring Wsiness type(s): Resmu2M (6) - rtare Man 12 s�ts, A�latt Otf Sa�� li9uor On Sale - SundaY. liQuor On Sale -100 s�5 or less (C), Gamblinp Lacation (Cfaa A). RECOMMENDATIONS: Approve(A) Reject(R) RSONAL SERVICE CANTRACTS MUST ANSWER THE FOLLOWING QUESTIONS: 1. Hes fhis DersoNfirtn ever wotked under a contract �r this depaNmeM? PLANNING COMMiSStON YES NO CIB COMMITTEE 2. Has this persoMrm ever heen e dy employee? CML SVC CINN, �'ES NO a. Does tnis persoMfi�m v� a sbn nw norma�N oossessed Dr amr currem cAy emo�oyee9 YES NO . kihisperswVfirmahrgetedvendoR YES NO FxpW(n all yes answen on aeparrte sheet antl attach to green aheet INITIATING PROBLEM, ISSUE, OPPOR7UNITY (Who, What, When, Where, Why): Requesting Couxil apprcval for T. J, 8elfs DBA 7.J. Bells iw L'puor OrrSale (CJ, Sunday On-Sale liquor, Resmurant (B), OffSale Meft, Gambling Laeation (C) Licenses at 1201 Jackson St. ADVANTAGES IF APPROVED: �O`QUSBCIE RQSiO�'C4? CF°tfB� �aR s, �. �s� ISADVANTAGES IF APPROVED: -.-. ___._._..,...,-,..�....��....�. .,. �. — -_. �..._._+ ISADVANTAGES IF NOTAPPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLf ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAINj CLASS III LICENSE APPLICATION THIS APPLICAI'IO'd IS SUB7ECT TO REVIEW BY Tf� PUBLIC PLEASE TYPE OR PRINT L�3 INK I'}pe of Licer.se(s) being applied for: �� CffY OF SAIidT PAL�L OL:ce of Licr.�se, L�s�a^lio;s 2nd Emiron:te�izl Pre:ection 3w scPr.a sc S,:.e 3� Si,-tt?a:il,.Y_:-��o•a 5'IC2 (6II)165-_W9� frzI613)3E5-91.4 S �Jf'f� S l�C (z Yvi Y� Company :� z,-nz; Corporaion / Psttne+ship i Sole Arop:ietoss6ip If business is incorporated, �ve date of incorporalion: _ Doing Busine5s As: �a� �t' ��S Business Address: �2�7 � � rl ( �S L� su�e nad,�, °' Between �•hat cross s�eets is the business loczted? < f V Are the preirases norc oxupied7 �� V11:at T}pe of Business? Mail To Address: Applicant Name and Home Adc CiN State Zip Wfiich side of the street? � W Date of Birth: _ f�� 7 P1ace of Birxh: �iR lfi�l �, Y l��ln Home Phone: ,�j rS �'c� �� Have you ever beea coni�cied of any felony, crime or ��iolation of any city ordinance other tkian traffic? YES NO � Date of azrest: Where? Charge: Conviction Sentence: List the names 2nd residences of three persons of good moral character, living within the Twin Cities IvTeuo Area, not related to the apglicant or financially interested in ihe premises or business, w�ho may be refe:red to as to the applicaaYs chazacter: Have any of tl�e above named licenses ever been revoked? � PHONE YES NO If yes, list the dates and reasons for revocation: 2/18/97 se«c na�,. c;�y s� Up List licenses which you curm�tly Lold, fotmerly bel� ot may have an inzerest in: -- Are you going to operate this 6usiness personall}'? � YES Firs[ \me FIomeAddraa: Stxcec`:ama Vfiddic Ltitiel I�TO If not, �rho will operate it? q� "�� I (\leiden) Last DaleofBirth Cih' � � Sizte Zip Plime\�ber YES �\O If the Ln��eger is not ��e sd as the operato;, A;e }'ou goir.g to hz��e a�z�E� or zssizzt ia t�s hnsv�ess? ple2se completz the ioilo��ing info..n2tioa: �iti� Homc 4ddras: Sfrxct\�c City I.ast Sffite Zip Deu of Binh Phone \imbet Please list }�our emplo}�nent history for the preti�ious fice (�) } eaz period: _.._ . — . ----. , ... �fldiess �'= - ':- -. -:,-.�,._:w-_,,.a�. ,�_..�.,--. _._-.,.,-..., _ ,._.. . .. __ _,... _._� _, __- - � /inn�/J �l/� Uld ��+ Y��L�c� C��ti"�1n ��. �l�-�/IL List all othet officers ofthe corporation: OFFICER TITLE HO?v7E NAME , (Office Held) ADDRESS HOME BUSI2�TESS DATE OF PHOI�TE PHONE BIRTH If business is a partnership, please inciude the following infonnation for each pa�tner (use additional pages if necessary): Fuat\'sme M�dAelnitiel (.'vteiden) Lasc DateafBirt2� SireciNamo City State � Zip PhoaeI3umber Fuat:Came bLddteInitiat (,Msidrn) Las[ DateofHirtt� Home Addtns: Strat Nsme City Stste Zip Phone \�ber MINNESOTA TAX IDEN'IIFICATION 13UNBER - Pursuant to the I,aws of Minnesota, 1984, Chapter 502, luticle 8, Seclion 2(270.72) (Tax Clearance�, Issuance of Licenses), licensing authorities aze required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tax identification number and the social security number of each license applicaat Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we ue required to advise you of the following reguding the use of the Minnesota Taac Identification Number: - This information may be used to deny the issuance or renewal of your license in the event you owe M'uuiesoffi sales, employer's w�ithholding or motor velucle e�ccise taxes; - Upon receiving this infarmation, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under the Federal Eachange of InfoRnation Agreement, the Department of Revrnue may supply this info:mation to the Intemai Revenue Service. Ivfiffie�nta Tax Identificarion Numbe� {Sales & Use Ta� Number) may be obtained from the State of Minnesota, Business Records Depar�ent, 10 RiverPark Plaza (612-296-6181). . Sacial Security Number: �7� —�i�' �� 7 � Minnesots Tax Identification Number: 1f a Minnesofa Tsx IdentiScation Nwnber is not required for the business being operated, indicate so by placing an "X" in the box ! �� ` vis�� -a�� CERTIFICATION OF WORKERS' CONPENSATION COVERAGE PURSUANT TO MINNESOTA STATUTE 176.182 I hereby c�rtify that I, or m}• company, azn in compliance uith the k'orkas' compensation insurance cocerage requiremrnts of Minnesota Statuie 1 i6.182, ssbdi�ision 2. I 21so undzrs.and that pro��ision offalc i*�fotmation in this certification constitutes s�cient govnds for ad�•erse action against all licenses held, incJuding rerocation and suspension of said licenses. ;�Tazne of?nswance Company: ��E' �r.tm(� / U� i.�� Policy2�Tumber: Covera¢efrom to I ha��e no emplo} ees cocered under �rorkers' compensatioa i.suranrz (II�ZTIALS) ANY FALSIFICATION OF A.\SWERS GIVEN OR MATERIt1L SUB�IITTED WIId, RESULT L1` DE\�L OF THIS APPLICATION I hereby stafe that I have answered all of the preceding questions, xnd that the infom�ation contained herein is hve and rarrect to tfie best of ,.<<'- .-_ my Ymou•ledge asrd beIief. I hereby state fwtliei ihat'i hace ieceived no money or ather conside"rauon, Ty u=ay of loan, gift; contribulion, or othernix, other than 21�eadp disclos,.d in the applicaIIOn which I ha�ith submined I also understa.nd this premise may be inspected hy police, fire, heaLh azd other city officizls at any and all ti�nes when the business is in operato�. FF'e nill accept pa� ment 6,� cash, check (mxde Fz} abSe ta CitF of Caint Paull �r er_dit =ar3 (iZ�C ot Visz). IFPAYINGBYCKE'DITGiRDPLEASECOMPLETETHEFOI,LOH'INGINFORMATION: �MasterCard �Visa EXPII2ATION DATE: ACCOUNT NUMBER: ' G�7�7/�� C7Ca7�� i�� 10� �rc�-n � . ��r�-( \arne of Car�oldu (alease vzint) •"Note: If this application is FoodQ.iquor related, please contact a City of Saint Paul Health Inspector, Steve Olson (266-9139), to re�riew plans. If any substanfial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-900'7 to apply for building pe;mits. If there are any ch�ges to the parking loi, floor space, or for new operations, piease contact a City of Saint Paul Zoning Inspector at 266-9008. All app6cations require the following documents. Please attach tHese documents n•Len submitting your applicatioa: 1. A detailed description of tfie design, locaGon and square footage of the premises to be licen.�esl (site plan). The following data should be on the site plan (prefetably on an 8 ll2" x I 1" or 8 1/2" x 14" paper): - Name, atidress, and phone numbet. - The scale should be stated such as 1" = 20'. ^N should be indicated towazd the top. - Placemeni of all pertineat features of the interior of the licensed facility such as seating areas, kitcLens, offices, repair atea, parking, rest rooms, ete. - - ffa request is for an addition or eapansion of the licensed faciiity, indicate both the current azea and the proposed e�.pansioa 2. A copy ofyour lease agrzemeat or proof of ownership of the property. SPECIFIC LICENSE APPLICA3TONS REQUIRE ADDTTIONAL IlVFORMATION. PLEASE SEE REVERSE FOR DETAII,S>»> �' ansrv�