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98-493Council File � 9� 1 1� Ordinance # RESOLUTION SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date �.1` RESOLVED: 1 - That application (ID #19980000405) for a Parking Lot License(s) 2 by PARK N JET LLC DBA PARK N JET at 2751 SHEPARD ROAD W be and 3 the same is hereby approved with the following conditions: 4 1. The parking £acility shall be arranged as per the approved 5 plan on file with LZEP. Yeas Navs Absent Requested by Department of: Benanav Adopted by Council: Date Adoption Certi£ied by Cou�: gy; a lpproved by May . Date Y= � � � Secretary Office of License, Inspections and Environmental Protection By: ��LtiCs t7 ��r� Form Approved by City Att V � � oved by Mayor for Submission to cil Green Sheet � LP60051 LIEP/Licensing GARY & PNONE ON COUNCIL AGEWDA BY (DATE) �� Hl!lu16Ht FOR ROUT9�G OROER GREEN SHEET 1❑ CRyA@orney �2 Counp7Research No. LP 60U51 R� -y�� TOT # OF SIGNA7URE PAGES (CL ALL LOC ATIONS FOR SIGNATURE� ACTION REQUESTED: Cournal approval of ttie fWiowing licerae appiication: License # 19980000405, for PARK N JET LLC, Doing Susir�ess As PARK N JET, st 2751 SHEPARD ROAD W, ineluding the following business type(s): Parldng Lot. RECOMMENDATIONS: Approve(A) Reject(R) � PLANNING COMMlSSION , CIB COMMITfEE _ CIVIL SVC CINN, 2SONAL SERVICE CONTR4CT5 MUST ANSWER THE FOLLOWMG QUESTIONS: Has Nris personlfirm ever worked under a coMracf fm tt�is depaAmeM? YES MO Has ihis personlfirm ever 6een a ciry employeel YES NO Doesthts pe�soMrm possess a skill not nortnaty possessed by am� curtenf c�Yy empioyee9 YES NO Is this perso�rtn a targetsd vendoR YES NO plain all yes answets on Sepatate sheet atW attath to green sheEt Requesting Council approvat for an apptication for a Parking Lot/Parking Ramp license by Park-NJet DBA Paiic-N-Jet, 2757 Shepard Road. IF �s�1��i� R��C�.[.rr� �°.ar,lF?F 3��a'�° � 7 't9�� IF NOT APPROVEp: 07AL AMOUNT OF TRANSACTION $ UNDiNG SOURCE IJANCIAL INFORMATION: XPLAIN} GfiUla�il FdeSB��Ch G�e�t@r COST/REVENUE SUDGETED (CIRCLE ONE) YES NO ACTIVlTY NUMBER qY -'��3 cLass �rr LICENSE APPLICATION CITY OF SAIidT PALZ �m of Liceivse, Ituptclions znd En�irmunrn(a1 Protection 350 st 2�,: Sv 5�ztc 3�t S�^�i.11«.^1RC:1 SSI+S (d32)ie6-9G'C sxC6117Z66oti3 TE�� APPL?CATION IS SLB:�ECT TO REV�W BY TZ-T� PUBLIC PLEASE TYPE OR PR�TT IN Ii3K o° T}pe of Licease(s} being applied for: �c� ��J S� � �n t� e 7� � S �� 7 � S Co�pangl�z-;�e: � ' - Gt � Q d uid-u. .�i rK-� If buiness is inco:porated, git e dzte of incor}�o*ation: 1��/ 9�`� � �.�•�' Boing Business As: �4 ' ✓l ..1 Q� ,, L � , C . Business Address: __ J y 6 D 3 � d � r Y\ S7YL-£ � 7` � T i' cZ ,`_ . �, � Business Phone: �r g O�/� a d S�t Address ��f n „�� Ciry Statc Zip f /� Betu'een a•hat cross s7eeu is the business located? > T wd.t7 D`' k-1 0l upt� Which side ofthe streec? lcJCS! Are the premises now occupied? What T}pe of Business? �i4'21ci n a f e T Mail To Address: � �l 9 (/ ��O.Q! d ��e7 �J7� �aZtG�, �/(� S .� / J `/ s�mc waar:�s ciry s�� ZsP Applicazxt Infoimation�: ` � / l�TUne and 7itle: l'l C' r a rd� �. �/� C7 �/�C !'l -- � 111 t , Fust .Va ,/� (� � �/ Lest Titie HomeAddress: _��-� �u/t�dn��KoLtA. /CbL /`�(��ctj`�t4� /�v" `S.S s� na c;ey � swu vP � / Date of Birth: � O yl 0�`f 7 Place of$irth: 7 T�e1.<d�, � Home Phone: 7 3 D' S7 �-� Have you ever been con�7cted of any felony, crime or tiiolation of any city ordinance other than traffic? YES I�TO � Date oi airest: Wnerel Charge: Com'iction: Sentence: List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financiaily interested in the premises or bvsiness, who may be refecred to as to the applicant's character: , , hTAME ADIIRESS � . PHOIQE 1,i r y ��e xny of the above named 2/18n37 Are you gcing to operzce this business pasonzll}'? � YES NO If not, �cho �3 ill operate it? q� y 9 3 Fust,l'emc \tiddleSnitixl (�:xidn) Irst DaleofBirt.h Home.93L-css: Street�eme City S!s:e Zip Phone\�ber Are �ou going to hz��e a ma,�ager or assistu�t in `u;s business� � YES ?� O ff the mz�aeer is not the sasne as the operator, plezse co:aplete t,'�e follo�ring i*iformzt:oa: �aral� STitass.+?.c ' F"urt�we ?.5e�±f�i ��.,�— Lest DatcofBirth Address: City Please list pour er.iplo};nent histozy for 1he preiious fice (5) ceas perio3: Business/Emplo�7nrnt � o Q/ . � .,-,� List all other office; s of the corporation: OFFICER IITLE HO?vSE NAME (O�'iceHeld) ADDRESS is a putriership, plerse include the follou5ng info.-mauon for each partner (use additionai pages if necessarg): (�1eid�} Eiome Addiess; Strcet'�aae Fuxttiame JS 7� // X ts S—� Stste Zip Phonc >%Izee� ST�iu� SS HOME BUSIIv'ESS DA1E OF PHONE PHOA'E BIRTH I,sst Staie Dats of B'vth M� Dau of Buth Street?:nme CiTy Stete Zip PhoM'.��be[ MINNESOTA TAX IDENTiFICATION NUMBER - Pwsuant to ihe Law=s of Mumesota, 1984, Chapter 502, Article 8, Seclion 2(270.72) (I'aY Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tar identification number znd ttte social security numbet of each license applicant (7nder the Ninnesota Government Data Praclices Act and the Federal Pri�•acy AcY of I 974, we are required to ad��ise you of the follow�ing regazding the use of the Minnesota Tvc Identification 2v'umber: - This infonnation may be used to deny the issuance or rrnewal of your license in the event you owe Minnesota sales, employer's u�ithholding or motor vehicie excise tates; - Upon receiving this informatioa, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under Lhe Federal Exchange of Infomation Agree;nest, the Department of Revenue may supply this information to the Intemai Rerenue Sen7ce. Tumesota Tax Identification I`TUmbers (Sales & Use Tae I�TUmber) may be obtained from the State of Minnesota, Business Records Department, � River Pazk Plaza (612-296-6181). xial Security I�Ti:mber: City Minnesota TaY Identification I3umber: �� 7 ' /�. �� 3.� J _ If a Minnesola Tax ldzntification ATirnber is not reqiied for the business being operated, mdicate so by placing an "X" in the box. ` 2/18/97 qY-4q3 CERI IFICATiON OF V,'ORTCERS' CO�Eh'SATIO:V C0� PLRSU,�,'v'T TO UIINI��SOTA STANTE 1 i6.132 I haeb}' cat.i.`y'that I, orm} a*a in compliance uith the �:e;l;r,s' compensation insurance co�•erzge requirenents of:�iinnesota Statute 176.182, subdi�ision 2. I x!so v_�de;stand 1h2Y p�ocison of fa?se cfornztion in this �cation conslitutes sv�cieat gow�ds for zdverse acuoa aezinst n11 licenses held, including re� ocatioa and suspeasioa of said licenses. ?� 11 �c1 — n e .P.Y.c_�/n�.rJ! s Policy Number: CoveraQe fro I have no e*nplo;�ees cocered nnder �i compensztion i_s,raace v (IhTTIAI,S) A.\�Y FALSIFICATION OF �\SWERS GIVE\T OR ?vIATERIAL SliB'tiIT1'TED WII.L RESLTLT L1' DE\'IAL OF THIS APPLICATIOi�I I hereby state that I h2��e ans�3 ered all of the preceding quest;or.s, and that the infonnation contzined herein is true and cortect to the best of my kno x'ledge and belizf. I hereby state finther ihzt I r eve recei��ed no money or other consideration, by w�ay of ]o2n, gift, con�Yibution, or othenzise, o�her than alrezd}° dis;7osa3 in the application � I bereuith submitted I zlso understand this przmise may be inspected by police, fire, healtl� and other city officials at zny and a11 times uhen Lhz business is in operation. (REQUTRED for a(I apQ[ications) VF'e eill accept pa}'ment by cash, check (made pa}'able to Citc of Saiot Paul) or credit card (14S/C or Visa). , 9d' Date IFPAYING SYCREDIT CARD PLEASE COMPLETE THE FOLLOWING IIVFORMATION: ❑ MasterCzrd � Visa EXPII2ATSON DATE: ❑o/o❑ ACCOUNf NU."✓iBER: ■■■■ ■■■■ ■■■■ ■■■■ �, Date "•Kote: If this application is Food/Liquor relate,� ple25e contact a City of Saint Paul Health Inspector, Steve Oison (266-9139), to ret�ew plans. If any substantial changes to struch:re aze anticipated, please contact a City of Saint Paul Plan Ex2svner at 266-9007 to apply for building permits. ffthere are asiy chaages to the parking lot, floor spacc, or for new operations, please contact a City of Saint Paul Zoning Inspector at 26b-9008. All apQlications require the folluRing documents. Please attach tfiese documents tvhen submitting }•our apptication: l. A detailed description of the design, location and square footage of the premises to be licensed (site plan). Tfie following data should be on the site plan (preferably on an 8 1!2" x I 1" or 8 1/2" x 14" paper): - Name, address, and phone number. - The scale should be stated such as I" = 20'. ^N sbould be indicated to«�ard the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, offices, repair area, puking, rest rooms, etc. - If a request is for an addition or expansion of the licensed facility, indicate both the current area and thz proposed eapansion. 2. A copy of your lease a� eement or proof of ounership of the propetty, SPECIFIC LICENSE APPLICATIONS REQL"II2E ADDTTIOi�TAL 71�'FOILMATIOY. PLEASE SEE REVERSE FOR AETAII.S >>>> ?��s,�9� Council File � 9� 1 1� Ordinance # RESOLUTION SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date �.1` RESOLVED: 1 - That application (ID #19980000405) for a Parking Lot License(s) 2 by PARK N JET LLC DBA PARK N JET at 2751 SHEPARD ROAD W be and 3 the same is hereby approved with the following conditions: 4 1. The parking £acility shall be arranged as per the approved 5 plan on file with LZEP. Yeas Navs Absent Requested by Department of: Benanav Adopted by Council: Date Adoption Certi£ied by Cou�: gy; a lpproved by May . Date Y= � � � Secretary Office of License, Inspections and Environmental Protection By: ��LtiCs t7 ��r� Form Approved by City Att V � � oved by Mayor for Submission to cil Green Sheet � LP60051 LIEP/Licensing GARY & PNONE ON COUNCIL AGEWDA BY (DATE) �� Hl!lu16Ht FOR ROUT9�G OROER GREEN SHEET 1❑ CRyA@orney �2 Counp7Research No. LP 60U51 R� -y�� TOT # OF SIGNA7URE PAGES (CL ALL LOC ATIONS FOR SIGNATURE� ACTION REQUESTED: Cournal approval of ttie fWiowing licerae appiication: License # 19980000405, for PARK N JET LLC, Doing Susir�ess As PARK N JET, st 2751 SHEPARD ROAD W, ineluding the following business type(s): Parldng Lot. RECOMMENDATIONS: Approve(A) Reject(R) � PLANNING COMMlSSION , CIB COMMITfEE _ CIVIL SVC CINN, 2SONAL SERVICE CONTR4CT5 MUST ANSWER THE FOLLOWMG QUESTIONS: Has Nris personlfirm ever worked under a coMracf fm tt�is depaAmeM? YES MO Has ihis personlfirm ever 6een a ciry employeel YES NO Doesthts pe�soMrm possess a skill not nortnaty possessed by am� curtenf c�Yy empioyee9 YES NO Is this perso�rtn a targetsd vendoR YES NO plain all yes answets on Sepatate sheet atW attath to green sheEt Requesting Council approvat for an apptication for a Parking Lot/Parking Ramp license by Park-NJet DBA Paiic-N-Jet, 2757 Shepard Road. IF �s�1��i� R��C�.[.rr� �°.ar,lF?F 3��a'�° � 7 't9�� IF NOT APPROVEp: 07AL AMOUNT OF TRANSACTION $ UNDiNG SOURCE IJANCIAL INFORMATION: XPLAIN} GfiUla�il FdeSB��Ch G�e�t@r COST/REVENUE SUDGETED (CIRCLE ONE) YES NO ACTIVlTY NUMBER qY -'��3 cLass �rr LICENSE APPLICATION CITY OF SAIidT PALZ �m of Liceivse, Ituptclions znd En�irmunrn(a1 Protection 350 st 2�,: Sv 5�ztc 3�t S�^�i.11«.^1RC:1 SSI+S (d32)ie6-9G'C sxC6117Z66oti3 TE�� APPL?CATION IS SLB:�ECT TO REV�W BY TZ-T� PUBLIC PLEASE TYPE OR PR�TT IN Ii3K o° T}pe of Licease(s} being applied for: �c� ��J S� � �n t� e 7� � S �� 7 � S Co�pangl�z-;�e: � ' - Gt � Q d uid-u. .�i rK-� If buiness is inco:porated, git e dzte of incor}�o*ation: 1��/ 9�`� � �.�•�' Boing Business As: �4 ' ✓l ..1 Q� ,, L � , C . Business Address: __ J y 6 D 3 � d � r Y\ S7YL-£ � 7` � T i' cZ ,`_ . �, � Business Phone: �r g O�/� a d S�t Address ��f n „�� Ciry Statc Zip f /� Betu'een a•hat cross s7eeu is the business located? > T wd.t7 D`' k-1 0l upt� Which side ofthe streec? lcJCS! Are the premises now occupied? What T}pe of Business? �i4'21ci n a f e T Mail To Address: � �l 9 (/ ��O.Q! d ��e7 �J7� �aZtG�, �/(� S .� / J `/ s�mc waar:�s ciry s�� ZsP Applicazxt Infoimation�: ` � / l�TUne and 7itle: l'l C' r a rd� �. �/� C7 �/�C !'l -- � 111 t , Fust .Va ,/� (� � �/ Lest Titie HomeAddress: _��-� �u/t�dn��KoLtA. /CbL /`�(��ctj`�t4� /�v" `S.S s� na c;ey � swu vP � / Date of Birth: � O yl 0�`f 7 Place of$irth: 7 T�e1.<d�, � Home Phone: 7 3 D' S7 �-� Have you ever been con�7cted of any felony, crime or tiiolation of any city ordinance other than traffic? YES I�TO � Date oi airest: Wnerel Charge: Com'iction: Sentence: List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financiaily interested in the premises or bvsiness, who may be refecred to as to the applicant's character: , , hTAME ADIIRESS � . PHOIQE 1,i r y ��e xny of the above named 2/18n37 Are you gcing to operzce this business pasonzll}'? � YES NO If not, �cho �3 ill operate it? q� y 9 3 Fust,l'emc \tiddleSnitixl (�:xidn) Irst DaleofBirt.h Home.93L-css: Street�eme City S!s:e Zip Phone\�ber Are �ou going to hz��e a ma,�ager or assistu�t in `u;s business� � YES ?� O ff the mz�aeer is not the sasne as the operator, plezse co:aplete t,'�e follo�ring i*iformzt:oa: �aral� STitass.+?.c ' F"urt�we ?.5e�±f�i ��.,�— Lest DatcofBirth Address: City Please list pour er.iplo};nent histozy for 1he preiious fice (5) ceas perio3: Business/Emplo�7nrnt � o Q/ . � .,-,� List all other office; s of the corporation: OFFICER IITLE HO?vSE NAME (O�'iceHeld) ADDRESS is a putriership, plerse include the follou5ng info.-mauon for each partner (use additionai pages if necessarg): (�1eid�} Eiome Addiess; Strcet'�aae Fuxttiame JS 7� // X ts S—� Stste Zip Phonc >%Izee� ST�iu� SS HOME BUSIIv'ESS DA1E OF PHONE PHOA'E BIRTH I,sst Staie Dats of B'vth M� Dau of Buth Street?:nme CiTy Stete Zip PhoM'.��be[ MINNESOTA TAX IDENTiFICATION NUMBER - Pwsuant to ihe Law=s of Mumesota, 1984, Chapter 502, Article 8, Seclion 2(270.72) (I'aY Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tar identification number znd ttte social security numbet of each license applicant (7nder the Ninnesota Government Data Praclices Act and the Federal Pri�•acy AcY of I 974, we are required to ad��ise you of the follow�ing regazding the use of the Minnesota Tvc Identification 2v'umber: - This infonnation may be used to deny the issuance or rrnewal of your license in the event you owe Minnesota sales, employer's u�ithholding or motor vehicie excise tates; - Upon receiving this informatioa, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under Lhe Federal Exchange of Infomation Agree;nest, the Department of Revenue may supply this information to the Intemai Rerenue Sen7ce. Tumesota Tax Identification I`TUmbers (Sales & Use Tae I�TUmber) may be obtained from the State of Minnesota, Business Records Department, � River Pazk Plaza (612-296-6181). xial Security I�Ti:mber: City Minnesota TaY Identification I3umber: �� 7 ' /�. �� 3.� J _ If a Minnesola Tax ldzntification ATirnber is not reqiied for the business being operated, mdicate so by placing an "X" in the box. ` 2/18/97 qY-4q3 CERI IFICATiON OF V,'ORTCERS' CO�Eh'SATIO:V C0� PLRSU,�,'v'T TO UIINI��SOTA STANTE 1 i6.132 I haeb}' cat.i.`y'that I, orm} a*a in compliance uith the �:e;l;r,s' compensation insurance co�•erzge requirenents of:�iinnesota Statute 176.182, subdi�ision 2. I x!so v_�de;stand 1h2Y p�ocison of fa?se cfornztion in this �cation conslitutes sv�cieat gow�ds for zdverse acuoa aezinst n11 licenses held, including re� ocatioa and suspeasioa of said licenses. ?� 11 �c1 — n e .P.Y.c_�/n�.rJ! s Policy Number: CoveraQe fro I have no e*nplo;�ees cocered nnder �i compensztion i_s,raace v (IhTTIAI,S) A.\�Y FALSIFICATION OF �\SWERS GIVE\T OR ?vIATERIAL SliB'tiIT1'TED WII.L RESLTLT L1' DE\'IAL OF THIS APPLICATIOi�I I hereby state that I h2��e ans�3 ered all of the preceding quest;or.s, and that the infonnation contzined herein is true and cortect to the best of my kno x'ledge and belizf. I hereby state finther ihzt I r eve recei��ed no money or other consideration, by w�ay of ]o2n, gift, con�Yibution, or othenzise, o�her than alrezd}° dis;7osa3 in the application � I bereuith submitted I zlso understand this przmise may be inspected by police, fire, healtl� and other city officials at zny and a11 times uhen Lhz business is in operation. (REQUTRED for a(I apQ[ications) VF'e eill accept pa}'ment by cash, check (made pa}'able to Citc of Saiot Paul) or credit card (14S/C or Visa). , 9d' Date IFPAYING SYCREDIT CARD PLEASE COMPLETE THE FOLLOWING IIVFORMATION: ❑ MasterCzrd � Visa EXPII2ATSON DATE: ❑o/o❑ ACCOUNf NU."✓iBER: ■■■■ ■■■■ ■■■■ ■■■■ �, Date "•Kote: If this application is Food/Liquor relate,� ple25e contact a City of Saint Paul Health Inspector, Steve Oison (266-9139), to ret�ew plans. If any substantial changes to struch:re aze anticipated, please contact a City of Saint Paul Plan Ex2svner at 266-9007 to apply for building permits. ffthere are asiy chaages to the parking lot, floor spacc, or for new operations, please contact a City of Saint Paul Zoning Inspector at 26b-9008. All apQlications require the folluRing documents. Please attach tfiese documents tvhen submitting }•our apptication: l. A detailed description of the design, location and square footage of the premises to be licensed (site plan). Tfie following data should be on the site plan (preferably on an 8 1!2" x I 1" or 8 1/2" x 14" paper): - Name, address, and phone number. - The scale should be stated such as I" = 20'. ^N sbould be indicated to«�ard the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, offices, repair area, puking, rest rooms, etc. - If a request is for an addition or expansion of the licensed facility, indicate both the current area and thz proposed eapansion. 2. A copy of your lease a� eement or proof of ounership of the propetty, SPECIFIC LICENSE APPLICATIONS REQL"II2E ADDTTIOi�TAL 71�'FOILMATIOY. PLEASE SEE REVERSE FOR AETAII.S >>>> ?��s,�9� Council File � 9� 1 1� Ordinance # RESOLUTION SAINT PAUL, MINNESOTA Presented By Referred To Committee: Date �.1` RESOLVED: 1 - That application (ID #19980000405) for a Parking Lot License(s) 2 by PARK N JET LLC DBA PARK N JET at 2751 SHEPARD ROAD W be and 3 the same is hereby approved with the following conditions: 4 1. The parking £acility shall be arranged as per the approved 5 plan on file with LZEP. Yeas Navs Absent Requested by Department of: Benanav Adopted by Council: Date Adoption Certi£ied by Cou�: gy; a lpproved by May . Date Y= � � � Secretary Office of License, Inspections and Environmental Protection By: ��LtiCs t7 ��r� Form Approved by City Att V � � oved by Mayor for Submission to cil Green Sheet � LP60051 LIEP/Licensing GARY & PNONE ON COUNCIL AGEWDA BY (DATE) �� Hl!lu16Ht FOR ROUT9�G OROER GREEN SHEET 1❑ CRyA@orney �2 Counp7Research No. LP 60U51 R� -y�� TOT # OF SIGNA7URE PAGES (CL ALL LOC ATIONS FOR SIGNATURE� ACTION REQUESTED: Cournal approval of ttie fWiowing licerae appiication: License # 19980000405, for PARK N JET LLC, Doing Susir�ess As PARK N JET, st 2751 SHEPARD ROAD W, ineluding the following business type(s): Parldng Lot. RECOMMENDATIONS: Approve(A) Reject(R) � PLANNING COMMlSSION , CIB COMMITfEE _ CIVIL SVC CINN, 2SONAL SERVICE CONTR4CT5 MUST ANSWER THE FOLLOWMG QUESTIONS: Has Nris personlfirm ever worked under a coMracf fm tt�is depaAmeM? YES MO Has ihis personlfirm ever 6een a ciry employeel YES NO Doesthts pe�soMrm possess a skill not nortnaty possessed by am� curtenf c�Yy empioyee9 YES NO Is this perso�rtn a targetsd vendoR YES NO plain all yes answets on Sepatate sheet atW attath to green sheEt Requesting Council approvat for an apptication for a Parking Lot/Parking Ramp license by Park-NJet DBA Paiic-N-Jet, 2757 Shepard Road. IF �s�1��i� R��C�.[.rr� �°.ar,lF?F 3��a'�° � 7 't9�� IF NOT APPROVEp: 07AL AMOUNT OF TRANSACTION $ UNDiNG SOURCE IJANCIAL INFORMATION: XPLAIN} GfiUla�il FdeSB��Ch G�e�t@r COST/REVENUE SUDGETED (CIRCLE ONE) YES NO ACTIVlTY NUMBER qY -'��3 cLass �rr LICENSE APPLICATION CITY OF SAIidT PALZ �m of Liceivse, Ituptclions znd En�irmunrn(a1 Protection 350 st 2�,: Sv 5�ztc 3�t S�^�i.11«.^1RC:1 SSI+S (d32)ie6-9G'C sxC6117Z66oti3 TE�� APPL?CATION IS SLB:�ECT TO REV�W BY TZ-T� PUBLIC PLEASE TYPE OR PR�TT IN Ii3K o° T}pe of Licease(s} being applied for: �c� ��J S� � �n t� e 7� � S �� 7 � S Co�pangl�z-;�e: � ' - Gt � Q d uid-u. .�i rK-� If buiness is inco:porated, git e dzte of incor}�o*ation: 1��/ 9�`� � �.�•�' Boing Business As: �4 ' ✓l ..1 Q� ,, L � , C . Business Address: __ J y 6 D 3 � d � r Y\ S7YL-£ � 7` � T i' cZ ,`_ . �, � Business Phone: �r g O�/� a d S�t Address ��f n „�� Ciry Statc Zip f /� Betu'een a•hat cross s7eeu is the business located? > T wd.t7 D`' k-1 0l upt� Which side ofthe streec? lcJCS! Are the premises now occupied? What T}pe of Business? �i4'21ci n a f e T Mail To Address: � �l 9 (/ ��O.Q! d ��e7 �J7� �aZtG�, �/(� S .� / J `/ s�mc waar:�s ciry s�� ZsP Applicazxt Infoimation�: ` � / l�TUne and 7itle: l'l C' r a rd� �. �/� C7 �/�C !'l -- � 111 t , Fust .Va ,/� (� � �/ Lest Titie HomeAddress: _��-� �u/t�dn��KoLtA. /CbL /`�(��ctj`�t4� /�v" `S.S s� na c;ey � swu vP � / Date of Birth: � O yl 0�`f 7 Place of$irth: 7 T�e1.<d�, � Home Phone: 7 3 D' S7 �-� Have you ever been con�7cted of any felony, crime or tiiolation of any city ordinance other than traffic? YES I�TO � Date oi airest: Wnerel Charge: Com'iction: Sentence: List the names and residences of three persons of good moral character, living within the Twin Cities Metro Area, not related to the applicant or financiaily interested in the premises or bvsiness, who may be refecred to as to the applicant's character: , , hTAME ADIIRESS � . PHOIQE 1,i r y ��e xny of the above named 2/18n37 Are you gcing to operzce this business pasonzll}'? � YES NO If not, �cho �3 ill operate it? q� y 9 3 Fust,l'emc \tiddleSnitixl (�:xidn) Irst DaleofBirt.h Home.93L-css: Street�eme City S!s:e Zip Phone\�ber Are �ou going to hz��e a ma,�ager or assistu�t in `u;s business� � YES ?� O ff the mz�aeer is not the sasne as the operator, plezse co:aplete t,'�e follo�ring i*iformzt:oa: �aral� STitass.+?.c ' F"urt�we ?.5e�±f�i ��.,�— Lest DatcofBirth Address: City Please list pour er.iplo};nent histozy for 1he preiious fice (5) ceas perio3: Business/Emplo�7nrnt � o Q/ . � .,-,� List all other office; s of the corporation: OFFICER IITLE HO?vSE NAME (O�'iceHeld) ADDRESS is a putriership, plerse include the follou5ng info.-mauon for each partner (use additionai pages if necessarg): (�1eid�} Eiome Addiess; Strcet'�aae Fuxttiame JS 7� // X ts S—� Stste Zip Phonc >%Izee� ST�iu� SS HOME BUSIIv'ESS DA1E OF PHONE PHOA'E BIRTH I,sst Staie Dats of B'vth M� Dau of Buth Street?:nme CiTy Stete Zip PhoM'.��be[ MINNESOTA TAX IDENTiFICATION NUMBER - Pwsuant to ihe Law=s of Mumesota, 1984, Chapter 502, Article 8, Seclion 2(270.72) (I'aY Clearance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the Minnesota business tar identification number znd ttte social security numbet of each license applicant (7nder the Ninnesota Government Data Praclices Act and the Federal Pri�•acy AcY of I 974, we are required to ad��ise you of the follow�ing regazding the use of the Minnesota Tvc Identification 2v'umber: - This infonnation may be used to deny the issuance or rrnewal of your license in the event you owe Minnesota sales, employer's u�ithholding or motor vehicie excise tates; - Upon receiving this informatioa, the licensing authority will supply it only to the Minnesota Department of Revenue. However, under Lhe Federal Exchange of Infomation Agree;nest, the Department of Revenue may supply this information to the Intemai Rerenue Sen7ce. Tumesota Tax Identification I`TUmbers (Sales & Use Tae I�TUmber) may be obtained from the State of Minnesota, Business Records Department, � River Pazk Plaza (612-296-6181). xial Security I�Ti:mber: City Minnesota TaY Identification I3umber: �� 7 ' /�. �� 3.� J _ If a Minnesola Tax ldzntification ATirnber is not reqiied for the business being operated, mdicate so by placing an "X" in the box. ` 2/18/97 qY-4q3 CERI IFICATiON OF V,'ORTCERS' CO�Eh'SATIO:V C0� PLRSU,�,'v'T TO UIINI��SOTA STANTE 1 i6.132 I haeb}' cat.i.`y'that I, orm} a*a in compliance uith the �:e;l;r,s' compensation insurance co�•erzge requirenents of:�iinnesota Statute 176.182, subdi�ision 2. I x!so v_�de;stand 1h2Y p�ocison of fa?se cfornztion in this �cation conslitutes sv�cieat gow�ds for zdverse acuoa aezinst n11 licenses held, including re� ocatioa and suspeasioa of said licenses. ?� 11 �c1 — n e .P.Y.c_�/n�.rJ! s Policy Number: CoveraQe fro I have no e*nplo;�ees cocered nnder �i compensztion i_s,raace v (IhTTIAI,S) A.\�Y FALSIFICATION OF �\SWERS GIVE\T OR ?vIATERIAL SliB'tiIT1'TED WII.L RESLTLT L1' DE\'IAL OF THIS APPLICATIOi�I I hereby state that I h2��e ans�3 ered all of the preceding quest;or.s, and that the infonnation contzined herein is true and cortect to the best of my kno x'ledge and belizf. I hereby state finther ihzt I r eve recei��ed no money or other consideration, by w�ay of ]o2n, gift, con�Yibution, or othenzise, o�her than alrezd}° dis;7osa3 in the application � I bereuith submitted I zlso understand this przmise may be inspected by police, fire, healtl� and other city officials at zny and a11 times uhen Lhz business is in operation. (REQUTRED for a(I apQ[ications) VF'e eill accept pa}'ment by cash, check (made pa}'able to Citc of Saiot Paul) or credit card (14S/C or Visa). , 9d' Date IFPAYING SYCREDIT CARD PLEASE COMPLETE THE FOLLOWING IIVFORMATION: ❑ MasterCzrd � Visa EXPII2ATSON DATE: ❑o/o❑ ACCOUNf NU."✓iBER: ■■■■ ■■■■ ■■■■ ■■■■ �, Date "•Kote: If this application is Food/Liquor relate,� ple25e contact a City of Saint Paul Health Inspector, Steve Oison (266-9139), to ret�ew plans. If any substantial changes to struch:re aze anticipated, please contact a City of Saint Paul Plan Ex2svner at 266-9007 to apply for building permits. ffthere are asiy chaages to the parking lot, floor spacc, or for new operations, please contact a City of Saint Paul Zoning Inspector at 26b-9008. All apQlications require the folluRing documents. Please attach tfiese documents tvhen submitting }•our apptication: l. A detailed description of the design, location and square footage of the premises to be licensed (site plan). Tfie following data should be on the site plan (preferably on an 8 1!2" x I 1" or 8 1/2" x 14" paper): - Name, address, and phone number. - The scale should be stated such as I" = 20'. ^N sbould be indicated to«�ard the top. - Placement of all pertinent features of the interior of the licensed facility such as seating areas, kitchens, offices, repair area, puking, rest rooms, etc. - If a request is for an addition or expansion of the licensed facility, indicate both the current area and thz proposed eapansion. 2. A copy of your lease a� eement or proof of ounership of the propetty, SPECIFIC LICENSE APPLICATIONS REQL"II2E ADDTTIOi�TAL 71�'FOILMATIOY. PLEASE SEE REVERSE FOR AETAII.S >>>> ?��s,�9�