91-1802������� � '� Council File ,� —� �
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i Green Sheet ,� 16414
RESOLUTION
C OF SAI PAUL, MINNESOTA
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Presented By
Referred To Committee: Date
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RESOLVED: That application (I.D. #29662) for a Health/Sport ub-� icense applied for
by John-Mark Pawlowski DBA Theta Wave, Inc. at 5 Port� d Avenue, #B-5, be
and the same is hereby approved with the follow' g conc�itions:
1. May serve only one customer at a time. � ��
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2. The tank must be located on ground �el to provide sufficient support
for the weight of the tank. �r
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3. Must be conducted as a home occ atio�
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Ye (` Navs Absent Requeated by Department of:
imon
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on License & Permit Division
acca ee
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z son BY� ��i
Adopted by Cou cil: Date Form Ap roved by City Attorney
Adoption Cer ified by Council Secretary �
By: 8'-� �q/
By:
A rov b Ma or: Date Approved by Mayor for Submission to
PP Y Y Council
By: gY;
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DEPARTMENT/OFFICE/COUNCIL DATE INITIATED
Finance/License GREEN SHEET �° 16414
CONTACT PERSON&PHONE INITIAL/DATE INITIAL/DATE
�DEPARTMENT DIRECTOR �CITY COUNCIL
Kris Van Horn/298-5056 assicN �CITYATTORNEY �CITYCLERK
NUMBERFOR
MUST BE ON COUNCIL ACaENDA BY(DATE)n ROUTING �BUDGET DIRECTOR �FIN.&MOT.SERVICES DIR.
FOR HEARING I S�� o�� ORDER MAYOR(OR ASSISTAN� CnTiN('TT.
CITY CLERK BY• � �
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION RE�UESTED:
Application (I.D. 4�29662) for a Health/Sports Club License
RECOMMENDATIONS:Approve(A)or Reject(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �• Has this personffirm ever worked under a contr8ct for this depertment?
_CIB COMMITfEE _ YES NO
2. Has this person/firm ever been a city employee?
_STAFF
- YES NO
_ DISTRIC7 COURT — 3. Does this erson/firm
p possess a skill not normally possessed by any current city employee?
SUPPORTS WHICH COUNCIL OBJECTIVE? YES NO
Explain all yea answers on separate sheet and attach to gresn sheet
INITIATINC3 PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where,Why):
John-Mark Pawlowski DBA Theta Wave, Inc. requests Council approval of his application for
a Health/Sports Club-A License at 569 Portland Avenue, 4�B-5. A].l applications and fees have
been submitted. Al1 required departments have reviewed and approved this application with
restrictions (See Attached Resolution) .
ADVANTAGES IF APPROVED:
DISADVANTAGES IF APPROVED:
RECEIVED
AUG 2 9 1991
� CITY CLERK
DISADVANTAOES IF NOT APPROVED:
Counc,! Researc� Center
AUG 2 7 1991
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED(CIRCLE ONE) YES NO
' FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) �i-,
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NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO.298-4225).
ROUTING ORDER:
Below are correct routings for the five most frequent types of documents:
CONTRACTS(assumes authorized budget exists) COUNCIL RESOLUTION (Amend Budgets/Accept. Grants)
1. Outside Agency 1. Department Director
2. Department Director 2. City Attorney
3. City Attorney 3. Budget Director -
4. Mayor(for contracts over$15,000) 4. Mayor/Assistant
5. Human Rights(for contracts over$50,000) 5. City Council
6. Finance and Management Services Director 6. Chiei Accountant, Finance and Management Services
7. Flnance Accounting
ADMINISTRATIVE ORDERS(Budget Revision) COUNCIL RESOLUTION (all others,and Ordinances)
1. Activity Manager 1. Department Director
2. Department Accountant 2. City Attorney
3. Department Director 3. Mayor Assistant
4, Budget Director 4. Ciry Council
5. City Clerk
6. Chlef Accountant, Finance and Management Services
ADMINISTRATIVE ORDERS(all others)
1. Department Director
2. City Attorney
3. Finance and Management Services Director
4. Ciry Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on whfch signatures are required and paperclip or flag
each of thase pages.
ACTION REQUESTED
Describe what the project/request seeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
issue. Do not write complete sentences. Begin each item in your list with
fl verb.
RECOMMENDATIONS
Complete if the issue In question has been presented before any body,public
or private.
SUPPORTS WHICH COUNCIL OBJECTIVE?
Indicate which Council objective(s)your projecUrequest supports by listing
the key word(s)(HOUSING, RECREATION, NEIGHBORHOODS, ECONOMIC DEVELOPMENT,
BUDGET, SEWER SEPARATION). (SEE COMPLETE LIST IN INSTRUCTIONAL MANUAL.)
PERSONAL SERVICE CONTRACTS:
This information will be used to determine the city's liability for workers compensation claims,taxes and proper civil service hiring rules.
INITIATING PROBLEM, ISSUE, OPPORTUNITY
Explsin the situation or conditions that created a need for your project
or request.
ADVANTAGES IF APPROVED
Indicate whether this is simply an annual budget procedure required by law/
charter or whether there are specific ways in which the City of Saint Paul
and its citizens will benefit from this projecUaction.
DISADVANTAC�ES IF APPROVED
What negative effects or major changes to existing or past processes might
this projecUrequest produce if It is passed (e.g.,traffic delays, noise,
tax increases or assessments)?To Whom?When? For how long?
DISADVANTAf3ES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved? Inabflity to deliver service?Continued high traffic, noise,
accident rate?Loss of revenue?
FINANCIAL IMPACT
Although you must tailor the information you provide here to the issue you
are addressing, in general you must answer two questions: How much is it
going to cost?Who is going to pay?
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�octob�r �.o, 19�s1
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Ms. Jac� McF�ak � � .
Ci�y Atfi�r[1ey ',
800 La�ndaoark Tow�Ce
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Dear. Ms.' t�lc2eak:
At the septeanber 24, 1991 City Cbuncil mQeting. the attschad applicatfon.
for a Health/Sporta Club:-A License, appli�d for by Jc�hn�Mark Pawlowak�.
- c�a Theta wave, Inc., wae referred to tho City !cr ravi�w anct rq000�mandatian.
Mr. Keseier of the Licenee Buraau reooma�endsd d�ial of�the application
due to caicQ�ns of C.i�e Firs Depsrtment. • , ; ,
Vary truly youra,
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Molly 'Rourk�e -� ,
City Clork
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N�:th -
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DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE /
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant ��r� I r l(,�����,,As IV�S(�� Home Address "J�Gl��(��c,�.n_�Q „�.t, . �-J
Business Name�h'E'.-� 1� �c� � .�yvlC_.. Home Phone ��� - [ �v�
Business Address �`�(���� ����Q 1�v�b� Type of License(s) �{t:.��Yl � �la(-�SVCu� - �`t
Business Phone �a, - �,(.�'� �.-..�(�„��,�
Public Hearing Date License I.D. � oZCj(�(� a
at 9:00 a.m. in the Counc 1 Chambers,
3rd floor City Hall and Courthouse State Tax I.D. �� �, ���Q
Date Notice Sent; Dealer � � �
to Applicant
� Federal Firearms 4� � ��
Public Hearing� 5-� �j� . � ; !
DATE INSPECTION
REVIEW VERFIED (COMPUTER) CONIlKENTS
A roved Not A roved
Bldg I & D '�I I
dY�
Health Divn. �
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Fire Dept. �
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Police Dept. �I � I
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License Divn. (
�I IZ � � (�
T1
City Attorney �
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Date Received:
Site Plan ��.,� ��
To Council Research
Lease or Letter Date
from Landlord ��
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CITY OF SAINT PAUL
LICENSE & PERMIT DIVISION
APPLICATION FOR CLASS III LICENSE
(IF YOU HAVE QUESTIONS REGARDING THIS FORM, CALL KRIS VAN HORN AT 298-5056)
Directions: THIS FORM MUST BE FILLED OUT WITH TYPEWRITER OR BY PRINTING IN
INK BY THE LICENSE APPLICANT
THIS APPLICATION IS SUBJECT TO REVIEW BY THE PUBLIC
1) Application for (type of license) ��S � �pe����.�Q• �t,.�
2) Located at (business address) ��� ��.TL�QuJD �V[ �"� ��.�' ►uL����-
(Number) (Name) (Type) (Dir)
3) Business I�atas �E�� V
orporation
4) If business is incorporated, give date of incorporation , 1��,
5) Doing Business As"(H�'TP� �AVE,Z.aG. Business Phone��1Z�al�.'����
(Name)
6) Mail to Address (if different than business address)
. �5 A��
STREET: Number Name Type Direction `
City State Zip Code
7) Your Name and Title�pt�•���. $ $ � ��,J,SK� ���(Z
(First) (Middle) (Maiden) (Last) (Title)
8) Home Address � Q��aVE. Phone# c�c�-��Q�{'
STREET: Number Name Type Direction
9) Date of Birth � �'� Place of Birth ���: i �
(Month, Day & Year)
10) Are you a citizen of the United States? �kD Native Naturalized
If you are not a U.S. resideat, you must�l�ave work authorization fram the
U.S. Immigration & Naturalization Service.
11) Have you ever been corivicted of any felony, crime or violation of any
city ordinance other than traffic? YES N0�_
Date of arrest ��_ , 19 Where j��
Charge N!A
Conviction �1�� sentence ���
.. �,�`��.
12) List the names and residences of three persons within the Metro Area of
good moral character, not related to the applicant or financially
interested in the premises or business, who may be referred to as to the
applicant's character:
�oN �J�ScH��A a511 6�v��uwl Y�.S, c'�P� 3����0 5
��'ELLA CHR�STtP*1So►,� 11u1� � _���a ��..�,� �'�y-�55�
�� � _ 1'�.ao�. ��a� D,�..��..� ,10��-003-�-
13j List licenses which you currently hold, or formerly held, or may have an
interest in:
�jA
14) Have any of the licenses listed by you in No. 14 ever been revoked?
Yes _ No,� If answer is "yes", list the dates and reasons
15) Are you going to operate this business personally? � If not,
who will operate it?
Name of Operator tJ�� Date of Birth (�}��
Home Address ���
(Number) (Name) (City) (State) (Zip)
Telephone Number ���A
16) Are you going to have a manager or assistant in this business? ��
If different from operator, please complete the following information:
Name N�� Address N��
Phone �J� � Date of Birth �J�Q
17) Including your present business/employment, what business/employment have
you followed for the past five years?
Business/Employ��nt ess
F'�cuo �.ES��vRPt�Yt' 300� 1�EaaE{���1 �vF � ��c�..S�,�rJ 55�#og
� C�iz�
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18) List all other officers of the corporation:
NAME TITLE HOI�iE ADDRESS HOME BUSINESS DATE OF BIRTH
� (Office Held) PHONE PHONE
�a1-R�
19) If business is partnership, list partner(s) , address, home and
business phone number.
Name �1
—,
Home Phone N�� Business Phone ��Q ,
Name �� Address �J�
Home Phone Sj��� Businass Phone �Q�
20) Attach to this application a detailed description of the design, location
and square footage of the premises to be licensed.
21) Attach to this application a copy of your lease agreement or proof of
ownership of the property. � pd�/�Ar..� d►
!
22) Between what cross streets is business located? �4�1�! Vo�-�
Which side of street? �'� \�1;�.�r�-�
23) Are premises now occupied? � What type of business? t,. �•�C
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL
SUBMITTED WILL RESULT I13 DENIAL OF THIS APPLICATION
I hereby state under oath that I have answered all of the above questions, and
that the information contained herein is true and correct to the best of my
knowledge and belief. I hereby state further under oath that I have received
no money or other consideration, by way of loan, gift, contribution, or
otherwise, other than already disclosed in the application which I herewith
submitted.
STATE OF MINNESOTA)
)ss.
COUNTY OF RAMSEY )
Subscribed and sworn to before me this - �� �(
ignature of Applicant j Date �
10�' y of JULY , 19 �
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�� �eHN c.wi�cox
NOTARY PUBLIC—MINNESOTA
' DAKOTA COUNTY
N ary Public ��r.crM County, MN My Cammission Exares Sept 24, 1996
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My Commission expires 9 � q6
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Sai nt Pau t Cit ' '
y Counc�l Publ �c
Hearing Notice License A Iication
pp
Dear Property Owners: FILE N0. L29662
Purpose
Application for a Health Sport Club A License.
RECEIVED
AUG 2 7 1991
CITY CLERK
Applicant
John-Mark Pawlowski dba Theta Wave Inc.
Location
569 Portland Ave B-5
Hearing
September 24, 1991
City Council Chambers, 3rd floor City Hall-Court House 9:00 a.m.
Questions
Notice sent by License and Permit Division, Department of Finance
and Management Services, Room 203 City Hall-Court House, St. Paul,
Minnesota 298-5056
Thi� date may be changed without the consent and/or knowledge of the
License and Permit Division. It is suggested that you call the City
Clerk's Office at 298-4231 if you wish confirmation.