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98-316Council File# �� .�" Ordinance �' ORIGINAL Presented By Referred To Green Sheet $ LP60040 - �f RESOLU710N CITY OF SAiNT PAUL, MINNESOTA Committee: Date 1 2 3 RESOLVSD: That application (ID #0035509) for a Malt Off Sale License(s) by EOODSMART LLC DBA FOODSMART at 544 UNIVERSITY AVE W be and the same is hereby approved. vPaa rua�s ah�ant Requested by Department of: OP£ice of I,icense, Inspections and Environmental Protection BY: S �,�'� Byc App� By: Form Approved by City A�rney � a� iroved by Mayor for Submission to incil Adopted by Council: Date Adoption Certified by Council Se etary DEPARSMENLOFFICEICOUNGL on'rE �N�i�n7Eo LIEP/Lkensing GREEN SHEET No.4P60040 � �j -�\� ONTACT PERSON & PHONE MitiaVDa�e IniliaVDate 100M JAMES (JiNn (612) 2&r9073 t� City AttartteY UST BE ON COUNCIL AGENDA BY (DATE) �51GN � HUMBERFOR � ��1Research RQUTiNG ORDER TOTAL# OF SIGNATURE PAGES (CLIP ALL LOCAT101J5 FOR SIGNANR� ACTION REQUESTED: Cousx� approva! of the tdiowing license appliption: ticem.,e # 0035509, for FOODSMART LLC, Doi� Susi�ss As POODSMART, at 544 UNtVERSITY AVE W. inciuding the tolbwing business type(s): Matt OH Sale. RECOMMENDAT{ONS: Apprwe(A) Reject{R) ERSONAL SERVICE cONTRACTS MUST ANSWER 7HE foLLOWING QUESTIONS: 1. Has this perso�rm ever worked umler a contract 4w this deperlmeM? � PLANNING COMMISSION yES roo CIB COMMITTEE 2. Has ihis persoMrtn ever been a ciry employee? �CML SVC CINN, YES NO 3. Dces this perso�rm pos5ess a skiil not rwrmalN P�esed by arry curteM city employee7 YES NQ -- 4. Is this pe�sonKmm aiargeted vendo(1 -- YES NO Erzplain all yes answers on separate sheet and attach to green sheet INITIATING PROBLEM, ISSUE, OPPORTUNtTY (V✓ho, What, When, Where, Why): Request GouacU approvai for Foodsmart LlC DBA Foodsmart for an Off-Sale Maft License at 544 University Ave. W. ADVANTAGES IF APPROVEO: ISADVANTAGESIFAPPROYED: DISADVAN7AGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ON� YES NO FUNDlNG SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) p� c� 04V li:�.r vwa � �'tY-� CLASS III �� ITY OF SAI2�T PAt3L �ce ofLicrnx, InspeC�o:u LICENSE APPLICATIO snd Emirauneatal Protection 350 5[ PC»r St Svitc 3'JO SzStt Pa:J, 4Emeo�a i<1�1 (612)2669� fsx(61')156�9126 � Bt.()t'�� `� y� THIS APPLiCATION IS SL'BJECT TO REVIEW BY TfL PUBLIC �j�'Q -' � 1 � � e, � � , � ` 7 � PLEASE TYPE OR PRIl3T IN IIvK `" 1 l �� w / � T}peofLicense(s)beingzppliedfor: :�^4'i;�. -� �_ ��:,� ��'��."cfi:� (,.�` )�e, $ L r S `�" — - S � - :� _ S -.:, v� — Company Nz.-ne: Co:�aration / PuEncrship / Sole Propricwnhip If business is incoiporattd, give date of incorpo: ation: Do;ng Business As: � Business Phone: S i Z_ -�! �-`� I Q7 � BusinessAddress: �44 liNi��(:i4TY 4VE. ti7 {�l��f� I�1 V hh1(�� Sm,.-t Adkaa City Statc 2ip Betu een u•hat cross streets is the business ]ocated? � V��._�'. , T ti �;, i l �::' ; r Which side of the street? �� a•�. � F', ; i r a� c Are the premises now occupied7 J� ti VJhat Type of Business� S',; ,�'r �', �r r, =T � MzilToAddress: �d-4- �J�7 V£RCiTy 4'v� CT PPi�' Nt� ih1 "�i SUee[ Adkrea� City Statc Zip Applicant Infonnalion: Name and Title: _ i ^ F'v�t `.tiddlc (blaiden) I,ast Titic HomeAddress: it�" �; °G2i ��.�c �.,:� a� fT i'1'�i "�`�1;�.� scre:c naa� c� s�� vp Date of Birth: t�: i�� i n= Place of Birth: i A r;; Home Phone: ��-�, �i -^. - 5 � rc� Have you e�er been n�iat of any fe3or.y, crime or violation of a�y city ordinance other thzn traffic? YES I.TO _� Date of arrest: Charge: _ Com�cGon: Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Meffo Area, not re]ated to the applicant or financially interested in the premises or business, who may be referred to as to the applicanPs chazacter: NA 1NE Whae? I_f�T�]�� PHONE I�i�G X�O!'d1= tii(i '�b'GPT Ivjla�ndL=f=�'HA A�IF_ ST ?nt'i "'111 y�t'�:i l�.n..a.-7T'-}7 t^?i.iV �C f�Ni— ;ihi SH�F'.i:''��ic A-ff c"' po.r" . sr'�� 5�i5f'.� f-1�=-7a i i�i;� �c;r�Nt= ?i�iT _cr:i��?tuF �;iC �"� P^_� 'inr .�.��(%.=C. FA-4-Z(�P � � List licenses which you currently hold, fom�erly beld, or may have an interest in: Have azry of the above nazned licenses eva been revoked? � YES _� NO If yes, list the dates and reasons for revocation: 2,'18/97 ,'tre }'ou going to operaTe this busintss personally? :� YES Home Address: SV«t �zme \�dd1e Wtial (!l:zidn) City YES Are you go:na to hace a manager or assistznt in Ilus business� piease co�ple+.e the followvzg i. First::za: xomeAadress: sr_a�zme Ci.y I�TO If not, �zho u ill operatz it? I.ast Sizte ��-��b `i�i'-1n. � Zip Pnane \umbcr ✓ NO If the masiagzr is not the same as the operator, Lrs[ Stsu Zip Phove\'�bet Please list }our emp]o}mern historv for the pre�dous five (5) }�eaz period: Business/Emolo�ment ddress A.'�iYrf+:4:d =i!l��`'.L ��r.J� ��r"I C/ac r�.� ;� �� Ar.� re �� r.��(� List all other officers of the corporation: OFFICER TITLE HOME HOME BUSIIvESS DA1E OF I�'ANE (OfficeHeld) ADDRESS PHOI��E PHONE BII2TH ��I�X. O�UN�=.�' ��i� Gi�G<'r�L,t� (�.d"'•-! 4(��_<�. y � _��c X: r'�' '. (.f � 2 '�/y-"� M4(? �!� fJ � i'"� t'A: :7-,r.;-�� C-��1�;n` ' ° �'� i, I�-n- If business is a patmr. slup, please include the following infmmation for each partner (use additional pages if necessazy): �--,_, ., � X i, r J- X � �� ; Firat \ame Middle Inilial ('✓iniden) Last Date ofB'vfh ��'7 �'��r�t,;�r��e A�tc, tiT rct�� G�nr hh1r',� e.2q-z<2q Home Add'ns: Street \ame City Stste Zip Phone \umb..-r - G JC : , f,: Fixst?:ame �fiddle Iaitisl (!.3aidrnJ Last �` Date ofBirfE� ��,�5 fJ < R� l• �� ,T — �a U V �✓ i f h'4 S� 2 Cf-�,'`3 - I kZ� HomeAddrar. SCUt:�ame / City State Zip ?hone'.�umber MIIQh'FSOTA'IAX IDENTIP'SCATIQN NUMBER - Pursuant to the Laws of Minnesot� 1984, Cbapter 502, Article 8, Sution 2{270.72) {Tax Clearance; Issuance of Licenses}, licensing authorities are tequired to pro�nde to the State of Minnesota Commissianer of Revenue, the Minnesota business tax idrntification number and the social security n�ber of each license applicant Under the Mmnesota Goveinment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification Number: - This information may be used to de:ry the issuance or renewal of your license in the evrnt you owe Mimiesota sa]es, employer's w�ithlwlding or motor vehic]e excise taxes; - Upon receiving this information, the licensing authority u7ll supply ii only to the MirmesoTa Department of Revenue. However, under the Federal Exchange of Informavon Agreement, the Department of Revenue may supply this infrnmation to the Internal Revenue Service. IvSnnesoffi TaY Identi5cation Nwnbers (Sales & Use Tax Number) may be obtained fmm the State of Minnesota, Business Records Depaztmen; 10 Riva Park Plaza (612-296-618 ] ). Social Securiry Number. `� �'�� a� ��I' Minnesota Tax Identification Number: ✓�S �� _ If a Mmnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. t� \fiddle Initizl (.Vizidc�) zn s.�s� q�-'JI(. CERTIFICA7ION OF WORKERS' CO?vfPENSATION CO\TERAGE PURSUANT TQ MR�'iQESOTA STANIE 176.182 I herehy ceRify that I, a mg company, azn in cqmpliznce �3ith the �rorkers compensation insurance coverage requirements of Minnesota Stztuie 176.182, subdivision 2. I�iso undecstand that provisioa of fise info�nation in this u.�rti�5cation constitutes s�cient grounds for zd�•erse action against a11 licenses held, including revocation xnd suspension of said licenses. I�'ame of Ir!surance Company; ' + = Policy IQumber: � z =�:. =r 4- Cocerage from S, ''. �-4 7 to Ti '; � �? I have no emplo} ees co�'ced under u�o;kers' compensztion i�s:rznce (L17I'LALS) Al�'Y FAZSIFICATION OF Al�SV4'ERS GIVEh' OR �IATEftIAL SUBMTTTED R'ILL REStiLT IN DENIAL O�S APPLICATION \ I hereby state that I have znsu ered all of the preceding questio , and 2hat the mformation contained herein is true and cAirzct to the best of my l:now�ledee and belief. I hereby s�.zte funher th;t I ha��e r ived no money or�er consideration, by ��ay of loa.-i, giff, coatr.bution, or othe:v.ise, oLher thzn zre.�C} dis: lo�l ir. tne �plicztion w Ifa�e��i su'�r.ritt I so undzrstand this premise mzy be inspected by police, fire, heaith znd other city officials at an}' �Zd 2ll iimes v�'hen t�;e busi�ess '' o�ration. 1 � � Signatum�tEQUIRED for all applications) D ate We srill acmpt pa}ment by cash, check (made payable to City of Sa t Pau� or credit card (711/C or Visa). IF PAYIArG BY CREDIT CARD PLEASE COMPLETE THE FOLLOWING INFORMATION: � MasterCasd � Visa EXPIl2ATION DATE: ❑o/o❑ of Car�older ACCOLNT NIJMBER: �:�■ ■ ■ ■ ■ ■ ■ ■_■_■_■ ■_■_■_■� Cazd Holder(required for all Date "*rote: If this application is Food/Liquor related, pleese contact a City of Saint Paul Health Inspecior, Steve Olson (266-9139}, to re�iew plans. If any substantial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply for building pemvu. If thae are azry changes to the parking lot, floor space, or for new operations, please mntact a City of Saint Paul Zonu3g Inspector at 266-9008. All applications mquire the foIlowing documents. Ylease attach these documents a•hen submitting your application: I. A detai3ed description of the design, location and square footage of the premises to be licensed (site plan). The follow�ing data should be on the site plan (preFerably on an 81t2" x i l" or 8 It2" x 14° paper): - Nazne, address, and phone number. - The scale should be stated such as I" = 20'. ^N shauld be indicated toward the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, offices, repair azea, puking, rest rooms, etc. - If a request is for an addition or expansion of the licensed faciliry, indicate both the current azea and the proposed eapansion. 2. A copy of yow lease agreement or proof of owmerstrip of the propary. SPECIFIC LICENSE APPLICATIONS REQUIRE ADDTTIONAL IN�'ORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> 4: v� a,g� Council File# �� .�" Ordinance �' ORIGINAL Presented By Referred To Green Sheet $ LP60040 - �f RESOLU710N CITY OF SAiNT PAUL, MINNESOTA Committee: Date 1 2 3 RESOLVSD: That application (ID #0035509) for a Malt Off Sale License(s) by EOODSMART LLC DBA FOODSMART at 544 UNIVERSITY AVE W be and the same is hereby approved. vPaa rua�s ah�ant Requested by Department of: OP£ice of I,icense, Inspections and Environmental Protection BY: S �,�'� Byc App� By: Form Approved by City A�rney � a� iroved by Mayor for Submission to incil Adopted by Council: Date Adoption Certified by Council Se etary DEPARSMENLOFFICEICOUNGL on'rE �N�i�n7Eo LIEP/Lkensing GREEN SHEET No.4P60040 � �j -�\� ONTACT PERSON & PHONE MitiaVDa�e IniliaVDate 100M JAMES (JiNn (612) 2&r9073 t� City AttartteY UST BE ON COUNCIL AGENDA BY (DATE) �51GN � HUMBERFOR � ��1Research RQUTiNG ORDER TOTAL# OF SIGNATURE PAGES (CLIP ALL LOCAT101J5 FOR SIGNANR� ACTION REQUESTED: Cousx� approva! of the tdiowing license appliption: ticem.,e # 0035509, for FOODSMART LLC, Doi� Susi�ss As POODSMART, at 544 UNtVERSITY AVE W. inciuding the tolbwing business type(s): Matt OH Sale. RECOMMENDAT{ONS: Apprwe(A) Reject{R) ERSONAL SERVICE cONTRACTS MUST ANSWER 7HE foLLOWING QUESTIONS: 1. Has this perso�rm ever worked umler a contract 4w this deperlmeM? � PLANNING COMMISSION yES roo CIB COMMITTEE 2. Has ihis persoMrtn ever been a ciry employee? �CML SVC CINN, YES NO 3. Dces this perso�rm pos5ess a skiil not rwrmalN P�esed by arry curteM city employee7 YES NQ -- 4. Is this pe�sonKmm aiargeted vendo(1 -- YES NO Erzplain all yes answers on separate sheet and attach to green sheet INITIATING PROBLEM, ISSUE, OPPORTUNtTY (V✓ho, What, When, Where, Why): Request GouacU approvai for Foodsmart LlC DBA Foodsmart for an Off-Sale Maft License at 544 University Ave. W. ADVANTAGES IF APPROVEO: ISADVANTAGESIFAPPROYED: DISADVAN7AGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ON� YES NO FUNDlNG SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) p� c� 04V li:�.r vwa � �'tY-� CLASS III �� ITY OF SAI2�T PAt3L �ce ofLicrnx, InspeC�o:u LICENSE APPLICATIO snd Emirauneatal Protection 350 5[ PC»r St Svitc 3'JO SzStt Pa:J, 4Emeo�a i<1�1 (612)2669� fsx(61')156�9126 � Bt.()t'�� `� y� THIS APPLiCATION IS SL'BJECT TO REVIEW BY TfL PUBLIC �j�'Q -' � 1 � � e, � � , � ` 7 � PLEASE TYPE OR PRIl3T IN IIvK `" 1 l �� w / � T}peofLicense(s)beingzppliedfor: :�^4'i;�. -� �_ ��:,� ��'��."cfi:� (,.�` )�e, $ L r S `�" — - S � - :� _ S -.:, v� — Company Nz.-ne: Co:�aration / PuEncrship / Sole Propricwnhip If business is incoiporattd, give date of incorpo: ation: Do;ng Business As: � Business Phone: S i Z_ -�! �-`� I Q7 � BusinessAddress: �44 liNi��(:i4TY 4VE. ti7 {�l��f� I�1 V hh1(�� Sm,.-t Adkaa City Statc 2ip Betu een u•hat cross streets is the business ]ocated? � V��._�'. , T ti �;, i l �::' ; r Which side of the street? �� a•�. � F', ; i r a� c Are the premises now occupied7 J� ti VJhat Type of Business� S',; ,�'r �', �r r, =T � MzilToAddress: �d-4- �J�7 V£RCiTy 4'v� CT PPi�' Nt� ih1 "�i SUee[ Adkrea� City Statc Zip Applicant Infonnalion: Name and Title: _ i ^ F'v�t `.tiddlc (blaiden) I,ast Titic HomeAddress: it�" �; °G2i ��.�c �.,:� a� fT i'1'�i "�`�1;�.� scre:c naa� c� s�� vp Date of Birth: t�: i�� i n= Place of Birth: i A r;; Home Phone: ��-�, �i -^. - 5 � rc� Have you e�er been n�iat of any fe3or.y, crime or violation of a�y city ordinance other thzn traffic? YES I.TO _� Date of arrest: Charge: _ Com�cGon: Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Meffo Area, not re]ated to the applicant or financially interested in the premises or business, who may be referred to as to the applicanPs chazacter: NA 1NE Whae? I_f�T�]�� PHONE I�i�G X�O!'d1= tii(i '�b'GPT Ivjla�ndL=f=�'HA A�IF_ ST ?nt'i "'111 y�t'�:i l�.n..a.-7T'-}7 t^?i.iV �C f�Ni— ;ihi SH�F'.i:''��ic A-ff c"' po.r" . sr'�� 5�i5f'.� f-1�=-7a i i�i;� �c;r�Nt= ?i�iT _cr:i��?tuF �;iC �"� P^_� 'inr .�.��(%.=C. FA-4-Z(�P � � List licenses which you currently hold, fom�erly beld, or may have an interest in: Have azry of the above nazned licenses eva been revoked? � YES _� NO If yes, list the dates and reasons for revocation: 2,'18/97 ,'tre }'ou going to operaTe this busintss personally? :� YES Home Address: SV«t �zme \�dd1e Wtial (!l:zidn) City YES Are you go:na to hace a manager or assistznt in Ilus business� piease co�ple+.e the followvzg i. First::za: xomeAadress: sr_a�zme Ci.y I�TO If not, �zho u ill operatz it? I.ast Sizte ��-��b `i�i'-1n. � Zip Pnane \umbcr ✓ NO If the masiagzr is not the same as the operator, Lrs[ Stsu Zip Phove\'�bet Please list }our emp]o}mern historv for the pre�dous five (5) }�eaz period: Business/Emolo�ment ddress A.'�iYrf+:4:d =i!l��`'.L ��r.J� ��r"I C/ac r�.� ;� �� Ar.� re �� r.��(� List all other officers of the corporation: OFFICER TITLE HOME HOME BUSIIvESS DA1E OF I�'ANE (OfficeHeld) ADDRESS PHOI��E PHONE BII2TH ��I�X. O�UN�=.�' ��i� Gi�G<'r�L,t� (�.d"'•-! 4(��_<�. y � _��c X: r'�' '. (.f � 2 '�/y-"� M4(? �!� fJ � i'"� t'A: :7-,r.;-�� C-��1�;n` ' ° �'� i, I�-n- If business is a patmr. slup, please include the following infmmation for each partner (use additional pages if necessazy): �--,_, ., � X i, r J- X � �� ; Firat \ame Middle Inilial ('✓iniden) Last Date ofB'vfh ��'7 �'��r�t,;�r��e A�tc, tiT rct�� G�nr hh1r',� e.2q-z<2q Home Add'ns: Street \ame City Stste Zip Phone \umb..-r - G JC : , f,: Fixst?:ame �fiddle Iaitisl (!.3aidrnJ Last �` Date ofBirfE� ��,�5 fJ < R� l• �� ,T — �a U V �✓ i f h'4 S� 2 Cf-�,'`3 - I kZ� HomeAddrar. SCUt:�ame / City State Zip ?hone'.�umber MIIQh'FSOTA'IAX IDENTIP'SCATIQN NUMBER - Pursuant to the Laws of Minnesot� 1984, Cbapter 502, Article 8, Sution 2{270.72) {Tax Clearance; Issuance of Licenses}, licensing authorities are tequired to pro�nde to the State of Minnesota Commissianer of Revenue, the Minnesota business tax idrntification number and the social security n�ber of each license applicant Under the Mmnesota Goveinment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification Number: - This information may be used to de:ry the issuance or renewal of your license in the evrnt you owe Mimiesota sa]es, employer's w�ithlwlding or motor vehic]e excise taxes; - Upon receiving this information, the licensing authority u7ll supply ii only to the MirmesoTa Department of Revenue. However, under the Federal Exchange of Informavon Agreement, the Department of Revenue may supply this infrnmation to the Internal Revenue Service. IvSnnesoffi TaY Identi5cation Nwnbers (Sales & Use Tax Number) may be obtained fmm the State of Minnesota, Business Records Depaztmen; 10 Riva Park Plaza (612-296-618 ] ). Social Securiry Number. `� �'�� a� ��I' Minnesota Tax Identification Number: ✓�S �� _ If a Mmnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. t� \fiddle Initizl (.Vizidc�) zn s.�s� q�-'JI(. CERTIFICA7ION OF WORKERS' CO?vfPENSATION CO\TERAGE PURSUANT TQ MR�'iQESOTA STANIE 176.182 I herehy ceRify that I, a mg company, azn in cqmpliznce �3ith the �rorkers compensation insurance coverage requirements of Minnesota Stztuie 176.182, subdivision 2. I�iso undecstand that provisioa of fise info�nation in this u.�rti�5cation constitutes s�cient grounds for zd�•erse action against a11 licenses held, including revocation xnd suspension of said licenses. I�'ame of Ir!surance Company; ' + = Policy IQumber: � z =�:. =r 4- Cocerage from S, ''. �-4 7 to Ti '; � �? I have no emplo} ees co�'ced under u�o;kers' compensztion i�s:rznce (L17I'LALS) Al�'Y FAZSIFICATION OF Al�SV4'ERS GIVEh' OR �IATEftIAL SUBMTTTED R'ILL REStiLT IN DENIAL O�S APPLICATION \ I hereby state that I have znsu ered all of the preceding questio , and 2hat the mformation contained herein is true and cAirzct to the best of my l:now�ledee and belief. I hereby s�.zte funher th;t I ha��e r ived no money or�er consideration, by ��ay of loa.-i, giff, coatr.bution, or othe:v.ise, oLher thzn zre.�C} dis: lo�l ir. tne �plicztion w Ifa�e��i su'�r.ritt I so undzrstand this premise mzy be inspected by police, fire, heaith znd other city officials at an}' �Zd 2ll iimes v�'hen t�;e busi�ess '' o�ration. 1 � � Signatum�tEQUIRED for all applications) D ate We srill acmpt pa}ment by cash, check (made payable to City of Sa t Pau� or credit card (711/C or Visa). IF PAYIArG BY CREDIT CARD PLEASE COMPLETE THE FOLLOWING INFORMATION: � MasterCasd � Visa EXPIl2ATION DATE: ❑o/o❑ of Car�older ACCOLNT NIJMBER: �:�■ ■ ■ ■ ■ ■ ■ ■_■_■_■ ■_■_■_■� Cazd Holder(required for all Date "*rote: If this application is Food/Liquor related, pleese contact a City of Saint Paul Health Inspecior, Steve Olson (266-9139}, to re�iew plans. If any substantial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply for building pemvu. If thae are azry changes to the parking lot, floor space, or for new operations, please mntact a City of Saint Paul Zonu3g Inspector at 266-9008. All applications mquire the foIlowing documents. Ylease attach these documents a•hen submitting your application: I. A detai3ed description of the design, location and square footage of the premises to be licensed (site plan). The follow�ing data should be on the site plan (preFerably on an 81t2" x i l" or 8 It2" x 14° paper): - Nazne, address, and phone number. - The scale should be stated such as I" = 20'. ^N shauld be indicated toward the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, offices, repair azea, puking, rest rooms, etc. - If a request is for an addition or expansion of the licensed faciliry, indicate both the current azea and the proposed eapansion. 2. A copy of yow lease agreement or proof of owmerstrip of the propary. SPECIFIC LICENSE APPLICATIONS REQUIRE ADDTTIONAL IN�'ORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> 4: v� a,g� Council File# �� .�" Ordinance �' ORIGINAL Presented By Referred To Green Sheet $ LP60040 - �f RESOLU710N CITY OF SAiNT PAUL, MINNESOTA Committee: Date 1 2 3 RESOLVSD: That application (ID #0035509) for a Malt Off Sale License(s) by EOODSMART LLC DBA FOODSMART at 544 UNIVERSITY AVE W be and the same is hereby approved. vPaa rua�s ah�ant Requested by Department of: OP£ice of I,icense, Inspections and Environmental Protection BY: S �,�'� Byc App� By: Form Approved by City A�rney � a� iroved by Mayor for Submission to incil Adopted by Council: Date Adoption Certified by Council Se etary DEPARSMENLOFFICEICOUNGL on'rE �N�i�n7Eo LIEP/Lkensing GREEN SHEET No.4P60040 � �j -�\� ONTACT PERSON & PHONE MitiaVDa�e IniliaVDate 100M JAMES (JiNn (612) 2&r9073 t� City AttartteY UST BE ON COUNCIL AGENDA BY (DATE) �51GN � HUMBERFOR � ��1Research RQUTiNG ORDER TOTAL# OF SIGNATURE PAGES (CLIP ALL LOCAT101J5 FOR SIGNANR� ACTION REQUESTED: Cousx� approva! of the tdiowing license appliption: ticem.,e # 0035509, for FOODSMART LLC, Doi� Susi�ss As POODSMART, at 544 UNtVERSITY AVE W. inciuding the tolbwing business type(s): Matt OH Sale. RECOMMENDAT{ONS: Apprwe(A) Reject{R) ERSONAL SERVICE cONTRACTS MUST ANSWER 7HE foLLOWING QUESTIONS: 1. Has this perso�rm ever worked umler a contract 4w this deperlmeM? � PLANNING COMMISSION yES roo CIB COMMITTEE 2. Has ihis persoMrtn ever been a ciry employee? �CML SVC CINN, YES NO 3. Dces this perso�rm pos5ess a skiil not rwrmalN P�esed by arry curteM city employee7 YES NQ -- 4. Is this pe�sonKmm aiargeted vendo(1 -- YES NO Erzplain all yes answers on separate sheet and attach to green sheet INITIATING PROBLEM, ISSUE, OPPORTUNtTY (V✓ho, What, When, Where, Why): Request GouacU approvai for Foodsmart LlC DBA Foodsmart for an Off-Sale Maft License at 544 University Ave. W. ADVANTAGES IF APPROVEO: ISADVANTAGESIFAPPROYED: DISADVAN7AGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION $ COST/REVENUE BUDGETED (CIRCLE ON� YES NO FUNDlNG SOURCE ACTIVITY NUMBER FINANCIAL INFORMATION: (EXPLAIN) p� c� 04V li:�.r vwa � �'tY-� CLASS III �� ITY OF SAI2�T PAt3L �ce ofLicrnx, InspeC�o:u LICENSE APPLICATIO snd Emirauneatal Protection 350 5[ PC»r St Svitc 3'JO SzStt Pa:J, 4Emeo�a i<1�1 (612)2669� fsx(61')156�9126 � Bt.()t'�� `� y� THIS APPLiCATION IS SL'BJECT TO REVIEW BY TfL PUBLIC �j�'Q -' � 1 � � e, � � , � ` 7 � PLEASE TYPE OR PRIl3T IN IIvK `" 1 l �� w / � T}peofLicense(s)beingzppliedfor: :�^4'i;�. -� �_ ��:,� ��'��."cfi:� (,.�` )�e, $ L r S `�" — - S � - :� _ S -.:, v� — Company Nz.-ne: Co:�aration / PuEncrship / Sole Propricwnhip If business is incoiporattd, give date of incorpo: ation: Do;ng Business As: � Business Phone: S i Z_ -�! �-`� I Q7 � BusinessAddress: �44 liNi��(:i4TY 4VE. ti7 {�l��f� I�1 V hh1(�� Sm,.-t Adkaa City Statc 2ip Betu een u•hat cross streets is the business ]ocated? � V��._�'. , T ti �;, i l �::' ; r Which side of the street? �� a•�. � F', ; i r a� c Are the premises now occupied7 J� ti VJhat Type of Business� S',; ,�'r �', �r r, =T � MzilToAddress: �d-4- �J�7 V£RCiTy 4'v� CT PPi�' Nt� ih1 "�i SUee[ Adkrea� City Statc Zip Applicant Infonnalion: Name and Title: _ i ^ F'v�t `.tiddlc (blaiden) I,ast Titic HomeAddress: it�" �; °G2i ��.�c �.,:� a� fT i'1'�i "�`�1;�.� scre:c naa� c� s�� vp Date of Birth: t�: i�� i n= Place of Birth: i A r;; Home Phone: ��-�, �i -^. - 5 � rc� Have you e�er been n�iat of any fe3or.y, crime or violation of a�y city ordinance other thzn traffic? YES I.TO _� Date of arrest: Charge: _ Com�cGon: Sentence: List the naznes and residences of three persons of good moral character, living within the Twin Cities Meffo Area, not re]ated to the applicant or financially interested in the premises or business, who may be referred to as to the applicanPs chazacter: NA 1NE Whae? I_f�T�]�� PHONE I�i�G X�O!'d1= tii(i '�b'GPT Ivjla�ndL=f=�'HA A�IF_ ST ?nt'i "'111 y�t'�:i l�.n..a.-7T'-}7 t^?i.iV �C f�Ni— ;ihi SH�F'.i:''��ic A-ff c"' po.r" . sr'�� 5�i5f'.� f-1�=-7a i i�i;� �c;r�Nt= ?i�iT _cr:i��?tuF �;iC �"� P^_� 'inr .�.��(%.=C. FA-4-Z(�P � � List licenses which you currently hold, fom�erly beld, or may have an interest in: Have azry of the above nazned licenses eva been revoked? � YES _� NO If yes, list the dates and reasons for revocation: 2,'18/97 ,'tre }'ou going to operaTe this busintss personally? :� YES Home Address: SV«t �zme \�dd1e Wtial (!l:zidn) City YES Are you go:na to hace a manager or assistznt in Ilus business� piease co�ple+.e the followvzg i. First::za: xomeAadress: sr_a�zme Ci.y I�TO If not, �zho u ill operatz it? I.ast Sizte ��-��b `i�i'-1n. � Zip Pnane \umbcr ✓ NO If the masiagzr is not the same as the operator, Lrs[ Stsu Zip Phove\'�bet Please list }our emp]o}mern historv for the pre�dous five (5) }�eaz period: Business/Emolo�ment ddress A.'�iYrf+:4:d =i!l��`'.L ��r.J� ��r"I C/ac r�.� ;� �� Ar.� re �� r.��(� List all other officers of the corporation: OFFICER TITLE HOME HOME BUSIIvESS DA1E OF I�'ANE (OfficeHeld) ADDRESS PHOI��E PHONE BII2TH ��I�X. O�UN�=.�' ��i� Gi�G<'r�L,t� (�.d"'•-! 4(��_<�. y � _��c X: r'�' '. (.f � 2 '�/y-"� M4(? �!� fJ � i'"� t'A: :7-,r.;-�� C-��1�;n` ' ° �'� i, I�-n- If business is a patmr. slup, please include the following infmmation for each partner (use additional pages if necessazy): �--,_, ., � X i, r J- X � �� ; Firat \ame Middle Inilial ('✓iniden) Last Date ofB'vfh ��'7 �'��r�t,;�r��e A�tc, tiT rct�� G�nr hh1r',� e.2q-z<2q Home Add'ns: Street \ame City Stste Zip Phone \umb..-r - G JC : , f,: Fixst?:ame �fiddle Iaitisl (!.3aidrnJ Last �` Date ofBirfE� ��,�5 fJ < R� l• �� ,T — �a U V �✓ i f h'4 S� 2 Cf-�,'`3 - I kZ� HomeAddrar. SCUt:�ame / City State Zip ?hone'.�umber MIIQh'FSOTA'IAX IDENTIP'SCATIQN NUMBER - Pursuant to the Laws of Minnesot� 1984, Cbapter 502, Article 8, Sution 2{270.72) {Tax Clearance; Issuance of Licenses}, licensing authorities are tequired to pro�nde to the State of Minnesota Commissianer of Revenue, the Minnesota business tax idrntification number and the social security n�ber of each license applicant Under the Mmnesota Goveinment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of the Minnesota Tax Identification Number: - This information may be used to de:ry the issuance or renewal of your license in the evrnt you owe Mimiesota sa]es, employer's w�ithlwlding or motor vehic]e excise taxes; - Upon receiving this information, the licensing authority u7ll supply ii only to the MirmesoTa Department of Revenue. However, under the Federal Exchange of Informavon Agreement, the Department of Revenue may supply this infrnmation to the Internal Revenue Service. IvSnnesoffi TaY Identi5cation Nwnbers (Sales & Use Tax Number) may be obtained fmm the State of Minnesota, Business Records Depaztmen; 10 Riva Park Plaza (612-296-618 ] ). Social Securiry Number. `� �'�� a� ��I' Minnesota Tax Identification Number: ✓�S �� _ If a Mmnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the box. t� \fiddle Initizl (.Vizidc�) zn s.�s� q�-'JI(. CERTIFICA7ION OF WORKERS' CO?vfPENSATION CO\TERAGE PURSUANT TQ MR�'iQESOTA STANIE 176.182 I herehy ceRify that I, a mg company, azn in cqmpliznce �3ith the �rorkers compensation insurance coverage requirements of Minnesota Stztuie 176.182, subdivision 2. I�iso undecstand that provisioa of fise info�nation in this u.�rti�5cation constitutes s�cient grounds for zd�•erse action against a11 licenses held, including revocation xnd suspension of said licenses. I�'ame of Ir!surance Company; ' + = Policy IQumber: � z =�:. =r 4- Cocerage from S, ''. �-4 7 to Ti '; � �? I have no emplo} ees co�'ced under u�o;kers' compensztion i�s:rznce (L17I'LALS) Al�'Y FAZSIFICATION OF Al�SV4'ERS GIVEh' OR �IATEftIAL SUBMTTTED R'ILL REStiLT IN DENIAL O�S APPLICATION \ I hereby state that I have znsu ered all of the preceding questio , and 2hat the mformation contained herein is true and cAirzct to the best of my l:now�ledee and belief. I hereby s�.zte funher th;t I ha��e r ived no money or�er consideration, by ��ay of loa.-i, giff, coatr.bution, or othe:v.ise, oLher thzn zre.�C} dis: lo�l ir. tne �plicztion w Ifa�e��i su'�r.ritt I so undzrstand this premise mzy be inspected by police, fire, heaith znd other city officials at an}' �Zd 2ll iimes v�'hen t�;e busi�ess '' o�ration. 1 � � Signatum�tEQUIRED for all applications) D ate We srill acmpt pa}ment by cash, check (made payable to City of Sa t Pau� or credit card (711/C or Visa). IF PAYIArG BY CREDIT CARD PLEASE COMPLETE THE FOLLOWING INFORMATION: � MasterCasd � Visa EXPIl2ATION DATE: ❑o/o❑ of Car�older ACCOLNT NIJMBER: �:�■ ■ ■ ■ ■ ■ ■ ■_■_■_■ ■_■_■_■� Cazd Holder(required for all Date "*rote: If this application is Food/Liquor related, pleese contact a City of Saint Paul Health Inspecior, Steve Olson (266-9139}, to re�iew plans. If any substantial changes to structure are anticipated, please contact a City of Saint Paul Plan Examiner at 266-9007 to apply for building pemvu. If thae are azry changes to the parking lot, floor space, or for new operations, please mntact a City of Saint Paul Zonu3g Inspector at 266-9008. All applications mquire the foIlowing documents. Ylease attach these documents a•hen submitting your application: I. A detai3ed description of the design, location and square footage of the premises to be licensed (site plan). The follow�ing data should be on the site plan (preFerably on an 81t2" x i l" or 8 It2" x 14° paper): - Nazne, address, and phone number. - The scale should be stated such as I" = 20'. ^N shauld be indicated toward the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, offices, repair azea, puking, rest rooms, etc. - If a request is for an addition or expansion of the licensed faciliry, indicate both the current azea and the proposed eapansion. 2. A copy of yow lease agreement or proof of owmerstrip of the propary. SPECIFIC LICENSE APPLICATIONS REQUIRE ADDTTIONAL IN�'ORMATION. PLEASE SEE REVERSE FOR DETAII.S >>>> 4: v� a,g�