91-2237�JiiI��N,A � �- .
I� �Council File # ` '�
. �''
� � Green Sheet ,� 17611
RESOLUTION
CITY OF SAIN PAUL, MINNESOTA
r �
Presented By
Referred To Committee: Date
RESOLVED: That Application (I.D. #75887) for an Off Sale 3.2 Malt and A/1 Grocery-A
License applied for by Selby Mart DBA Selby Mart (Abdulazim A. Wazwaz -
Owner) at 809 Selby Avenue be and the same is hereby approved.
Yeas Navs Absent Requested by Department of:
imon _
oswi z
on �j� License & Permit Division
acca ee �
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Adopted by Council: Date ( � - �v=� � Form Approved by City Attorney
Adoption if'ed by Cou il Secretary �
sy: . �' /p •/� • /
By: �
� Approved by Mayor for Submission to
Approved by or: D e `"' `� Council
BY= By:
•;a::Ea";»4�:{ �
. _ ��C 21
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DEPI� MENT/OFFICFJCOUNCIL DATE INITIATED N.O 17 611 �
FYiian�e/License GREEN SHEET -
CONTACT PERSON&PHONE INITIAVDATE INITIAUDATE
�DEPARTMENT OIRECTOR �CITY COUNCIL
Kris Van Horn/298-5056 assicN Q CITYATTORNEY n CITYCLERK
NUMBER FOR �r
�������n��A��t�d��lA(E) ORDERG ❑BUOGETDIRECTOR �FIN.&MOT.3ERVICESDIR.
� t�I 3 � �MAYOR(OR ASSISTANT) [2] Council Research
l
TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION REQUESTED:
Application (I.D. ��75887) for an Off Sale 3.2 Malt and A/1 Grocery-A License
RECOMMENDATIONS:Approve(A)or ReJect(R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING QUESTIONS:
_PLANNING COMMISSION _ CIVIL SERVICE COMMISSION �• Has this person/firm ever worked under a contract for this departmentl
_CIB COMMITfEE _ YES NO
2. Has this person/firm ever been a city employee?
_STAFF — YES NO
_DISTRICT COURT _ 3. Does this personlfirm�ssess a sklll not nofmall ssessed
y po by any current city employee4
SUPPORTS WHICH COUNCIL OBJECTIVE7 YES NO
Explaln all yes answsrs on separats shest and attach to yresn sh�et
INITIATING PROBIEM,ISSUE,OPPORTUNITY(Who,Whet,When,Where,Why):
Selby Mart DBA Selby Mart (Abdulazim A. Wazwaz-Owner) requests Council approval of its
application for an Off Sale 3.2 Ma.lt and A/1 Grocery-A License at 809 Selby Avenue. All
applications and fees have been submitted. All required departments have reviewed and
approved this application.
ADVANTAQES IF APPROVED:
DISADVANTA(iES IF APPROVED:
DISADVANTAGES IF NOT APPROVED:
RECEIVED Council Research C��t�r
NOV 2 0 '�g�� NOV 1 9 1991
CITY CLERK
TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED(CIRCLE ONE) YES NO
FUNDING SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION:(EXPLAIN) d w
NOTE: COMPLETE DIRECTIONS ARE INCLUDED IN THE GREEN SHEET INSTRUCTIONAL �" t�
MANUAL AVAILABLE IN THE PURCHASING OFFICE(PHONE NO. 298-4225). �
ROUTIPIG ORDER:
Below are correct routings for the five most frequent rypes 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. Ciry Council
8. Finance and Management Services Director 6. Chief Accountant, Finance and Management Services
7, Finance Accounting
ADMINISTRATIVE ORDERS(Budget Revision) COUNCIL RESOLUTION (all others,and Ordinances)
1. Activity Manager 1. Department Director
2. Department Accountant 2. Ciry Attorney
3. Department Dlrector 3. Mayor Assistant
4. Budget Directar 4. Ciry Council
5. Ciry Clerk
6. Chief Accountant, Finance and Management Services
ADMINISTRATIVE ORDERS(all others)
1. Department Director
2. Ciry Attorney
3. Finance and Management Services Director
4. City Clerk
TOTAL NUMBER OF SIGNATURE PAGES
Indicate the#of pages on which signatures are required and paperclip or flag
each of thssa pe�es.
ACTION REQUESTED
Describe what the proJecUrequest seeks to accomplish in either chronologi-
cal order or order of importance,whichever is most appropriate for the
issue. Do not wriie complete sentences. Begin each item in your list with
a 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
Explain 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 project/action.
DISADVANTAQES IF APPROVED
What negative effects or major changes to existing or past processes might
this projecVrequest produce if it is passed(e.g.,traffic delays, noise,
tax increases or assessments)?To Whom?When?For how long?
DISADVANTACiES IF NOT APPROVED
What will be the negative consequences if the promised action is not
approved7 Inabiliry to deliver service?Continued high traffic, noise,
axident rate?Loss of revenue?
FINANCIAL IMPACT
Atthough 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?
��/aa 3�
�
DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE /
INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by
Lic Enf Aud
Applicant � ��' ,�{m Home Address . �
Business Name ���� Home Phone
�LZ -! � �1
Business Address �[��1 �� 1�., � . Type of License(s) ��� �� .3 .�
��
Business Phone �Z�j i - � � �� ,���_ •
Public Hearing Date �a I (p l Gt I License I.D. � �`J ��
at 9:00 a.m. in the Council Chambers, `�
3rd floor City Hall and Courthouse State Tax I.D. 4� �`C(�o� ��
Date Notice Sent; Dealer � �� ��
to Applicant
Federal Firearms � �j/l �
Public Hearing
DATE INSPECTION
REVIEW VERFIED (COMPUTER) COrIl�IENTS
A roved Not A roved
Bldg I & D I
1�1 t�5 �
Health Divn. �
�
Fire Dept. IJ �
���� d �
Police Dept.
tv ( �--� � ak
License Divn. (
�t � , � � C�4`1
City Attorney �
l� � /� f � �
Date Received:
Site Plan (}� �e,
To Council Research
Lease or Letter Date .
from Landlord -
. , C��� �a3'
. �
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) _ �a.S S�a �.`ah � /g �e e i✓ L,'t pNSE'
2) Located at (business address) �'0 9 Se�6,rr�✓e Sf, PaK � /y/� SS�dS�
(Number) (Name) (Type) (Dir)
3) Business Name Se l"y J I a/ /-•
Corporation, Partnership or Sole Proprietorship
4) If business is incorporated, give date of incorporation ��� , 19
5) Doing Business As Business Phone
(Name)
6) Mail to Address (if different than business address)
$a y, �
STREET: Number Name Type Direction
City State Zip Code
7) Your Name and Title �d4�L,`,,,, /�; �Gr Z c�-.x� Q wti ev
(First) (Middle) (Maiden) (Last) (Title)
8) Home Address yd yd Ly�r�4 k f�/o �p� O�f/(� S 5 y/o'Z Phone# S���� ��
STREET: Number Name Type Direction
9) Date of Birth �c.l� �,$' ��53 place of Birth T e r u s� �e 4», �sr a ��
(Month, Day & Year)
10) Are you a citizen of the United States? � Native Naturalized
If you are not a U.S. resident, you must have work authorization from the �
U.S. Immigration & Naturalization Service.
11) Have you ever been convicted of any felony, crime or violation of any
city ordinance other than traffic? YES NO �(
Date of arrest , 19 Where
Charge
Conviction Sentence
�q/ _aa��
�
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:
�N E ADDRESS PHONE
!�z ' sa.,. /��S a�/; � S'a o C ti,`� 9 e /t�� N�sy��/?.?Z
C j''1's Tn /IA �/0. /� 0`� 6 �6 g/oc� ;a 9 /0., /y� � Ssf'�7 �.Z�v��/7�
/
To � �, /`/��f,�/� 3 3 ss ,y��� w� f �F a !� v� �sY� c 7�/-5��/
13) List licenses which you currently hold, or formerly held, or may have an
interest in:
�0 y �
14) Have any of the licenses listed by you in No. 14 ever been revoked? �j�
Yes _ No _ If answer is "yes" , list the dates and reasons
15) Are you going to operate this business personally? �e S If not,
who will operate it?
Name of Operator Date of Birth
Home Address
(Number) (Name) (City) (State) (Zip)
Telephone Number
16) Are you going to have a manager or assistant in this business? /X �
If different from operator, please complete the following information:
Name Address
Phone Date of Birth
17) Including your present business/employment, what business/employment have
you followed for the past five years?
Business/Emplovment Address
?� 6 3s9 Se C. fl�p9- ��•�� V
4/r 5 `x a n r Ha 0. /"00� � L. � o �'���c a •u Z/� � d�i � � �/ Ys
� 6 y,� so s a ��d,�, �.
SQIrS GuAn Sr � � �o , � / �006 �° `1� � Y�"S
. . . �q�-aa3�
, �
18) List all other officers of the corporation: 1fi//�
NAME TITLE HOME ADDRESS HOME BUSINESS DATE OF BIRTH
(Office Held) PHONE PHONE
19) If business is partnership, list partner(s) , address, home and �/�
business phone number.
Name
Home Phone Business Phone
Name Address
Home Phone Business Phone
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 agreernent or proof of
ownership of the property.
22) Between what cross streets is business located? �' ��S �` y� U,`c �a✓�� 4
Which side of street? �o y t 1il
23) Are premises now occupied? ,��°SWhat type of business? ��o � '` �ct S t� B��Y
�—
ANY FALSIFICATION OF ANSWERS GIVEN OR MATERIAL
SUBMITTED WILL RESULT IN 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 RA."ISEY )
Subscribed and sworn to before me this f-/pp� A?-�cyv� `�-Z`i�'-`Z
Signature of Applicant / Date
� day of s� �e.,bt,, 19 9� r�s� '
- ` r"� JOHN C.MERRILL .
�� _ NOTAR�PUBLIG--MINNESOTA
HENNEPIN COUNTY
� J/ My Commpsion Exqres Jan. 12, 1997
Notary Public 77 ryne ;,� County, MN „ '
My Commission expires .� �