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91-2238 O!RIGINAL �, � �� Council File # `� � Green Sheet # 17607 RESOLUTION ITY OF SA T PAUL, MINNESOTA � � Presented By Referred To Committee: Date RESOLVED: That Application (I.D. #11917) for the transfer of a Gas Station-3 Pumps, 5 Additional Pumps, and Cigarette License at 809 Selby Avenue, currently issued to George J. Deutsch be and the same is hereby transferred to Selby Mart DBA Selby Mart (Abdulazim A. Wazwaz - Owner) at the same address. Yeas Navs Absent Requested by Department of: imon � oswz z on � License & Permit Division acca ee � e man i une i i son i- BY� Adopted by Council: Date (�-� ('>�� Form A roved b Cit Attorne -� PP Y Y Y Adoption Certified by Cou i Secretary ' By: �0 ' /g �q� By: A roved b or: D e .. Approved by Mayor for Submission to PP y � y `'� Council BY= By: �aF�� r� ? 1'91 �l�-��3� � DEPARTMEI�T/OFFICE/SOUNCIL DATEINITIATED GREEN SHEET NO' � ■ �O / Finance/License . CONTACT PERSON 8 PHONE INITIAUDATE INITIAUDATE �DEPARTMENT DIRECTOR CITY COUNCII Kris Van Horn/298-5056 ASSIGN �CITYATTORNEY �CITYCLERK I�J��,B��l��f�,� �4QZ DA BY(DATE) NUMBER FOR ❑ ❑ ROUTING BUDGET DIRECTOR FIN.&MCiT.SERVICES DIR. � ��' ORDER MAYOR(ORASSISTANT) Council Research Must be to Cit Clerk : ��z.-{ ❑ � TOTAL#OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTED: Application (I.D. ��11917) for the transfer of a Gas Station-3 Pumps, 5 Additional Pumps, and Cigarette License RECOMMENDATIONS:Approve(A)or Re)ect(R) PERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING�UESTIONS: _PLANNING COMMISSION _CIVIL SERVICE COMMISSION �• Hes this person/firm ever worked under a contract for this department? _CIB COMMITTEE _ YES NO _STAFF _ 2. Has this person/firm ever been a city employee? YES NO _ DiSTRiCT COURT _ 3. Does this person/firm possess a skill not normally possessed by any current city employee? SUPPORTS WHICH COUNCIL OBJECTIVEI YES NO Explaln all yes answers on separate shest and attach to green shest INITIATING PROBLEM,ISSUE,OPPORTUNITY(Who,What,When,Where,Why): Selby Mart DBA Selby Mart (Abdulazim A. Wazwaz-Owner) requests Council approval of its application for the transfer of a Gas Station-3 Pumps, 5 Additional Pumps and Cigarette License at 809 Selby Avenue currently issued to George J. Deutsch at the same address. All applications and fees have been submitted. All required departments have reviewed and approved this application. ADVANTAGES IF APPROVED: DI3ADVANTAGES IF APPROVED: DISADVANTAdES IF NOT APPROVED: RECEIVED ��r�c�f ��-;��E�r �,�� . Nov 2 01991 �MTY CLERK NOV 1 9 1991 TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED(CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER FINANCIAI INFORMATION:(EXPLAIN) �� 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. Ciry 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. 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. City Attorney 3. Department Director 3. Mayor Assistant 4. Budget Director 4. Ciry Council 5. City 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 these 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 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 projecVrequest 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 Ciry of Saint Paul and its citizens will benefit from this projecUaction. DISADVANTAGES 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? DISADVANTAGES IF NOT APPROVED What will be the negative consequences if the promised action is not approved?Inability 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? ��a3�' . . � DIVISION OF LICENSE AND PERMIT ADMINISTRATION DATE / �dl� ��-t� INTERDEPARTMENTAL REVIEW CHECKLIST Appn Processed/Received by Lic Enf Aud Applicant�y�� '�,�� Home Address G�(��(D �Y��1C�. �� l/l.t� - Business Name _ S�bi�, ��A ,r{- Home Phone SZ�- " ��1 � Business Address -I�v . Type of License(s) � � Business Phone �q/ _ � � ) � - ( r�,,,J _ Public Hearing Date � ,. 1C7. �,I License I.D. 4� �l C( f ✓] at 9:00 a.m. in the Council Chambers, 3rd floor City Hall and Courthouse State Tax I.D. �� C.��ja•3o��- Date Notice Sent; Dealer � �� to Applicant Federal Firearms 4� � �(� Public Hearing DATE INSPECTION REVIEW VERFIED (COMPUTER) COMMEENTS A roved Not A roved Bldg I & D � Health Divn. � � Fire Dept. I �� z� i � � Police Dept. 'v� '� ( � �j License Divn. f �: � i� I City Attorney I l� � �� Date Received: Site Plan - To Council Research Lease or Letter Date f rom Landlord C1� �i'�y�-��3� . � CITY OF SAINT PAUL LICENSE & PERMIT DIVISION APPLICATION FOR CLASS III LICENSE (IF YOU HAVE QUESTIONS REGARDIIv'G 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 APPLICA.NT THIS APPLICATION IS SUBJECT TO REVI£W BY THE PUBLIC 1) Application for (type of license) G d.S S�a 7�.`in +� � �e �' L��t pNSE' 2) Located at (business address) (�'0 9 Se�6r�✓Q 51�� /'aK � /y/� S S��y (Number) (Name) (Type) (Dir) 3) Business Name s� ��y / ! a►' �. , Corporation, Partnership or Sole Proprietorship 4) If business is incorporated, give date of incorporstion ��' , 19 5) Doing Business As Business Phone (Nsme) b) Mail to Address (if different thsn business address) S a c� � STREET: Number Name Type Direction City State Zip Code 7) Your hame and Title �d4� L,�,,,, /�; �a Z c�a y Q ws► e v (First) (Middle) (Maiden) (Last) (Title) 8) Home Address yd�6 Lya dt l� x/o J'J'p� /tr/�/ S g y/e� Phone� S�-�� STREET: Numb r Nsme Type Direction 9) Date of Birth �c� �,$' �9s3 place of Birth 1 e � u Sa �� 4»+ .�sr � �� (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 k'here Charge Conviction Sentence ��'/a��' . ✓ 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: � - Ny�E ADDRESS PHONE � ��z ' Sa.,� /��sa�; � S�o o Cti.`u y� a /�,.� �1�/s asy �1a-y,>.Z ° '-7— C1-'�"s �n 1�0. v0.7'L v'� 6 �6 ��oo� ;a 9 /0., /yP � Ssf'�7 7.?�76�/7JC' - ?� �/ 7 /l�Vf,`// 7 � ss- �7,�awR T R a /1 V� ssr� � ��-s7o�/ 13) List licenses which you currently hold, or formerly held, or msy have sn interest in: � �o n $ 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? �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? /� a If different from operstor, please complete the following infor�ation: Name Address Phone Date of Birth 17) Including your present business/employment, what business/employment have you followed for the past five years? Business/Em�lovment Address p / 6 3 S 9 S. l. f f p y� G.-,�-� ,2 �/r s 4�i S sx a a __/1 � isa a Foo� d G.'➢v e r C�'�� ` Y� Il� ro �G S� � / f a�r S Gw o.., S T f � �o � G S/,6 S� f / 6 G�6 ,� q � y r S ��z�' ✓ 18) List all other officers of the corporation: �/� NAME TITLE HOME ADDRESS HOME BUSINESS DATE OF BIRTH (Office Held) PHOrE PHONE 19) If business is partnership, list partner(s) , address, home and ��i/� business phone number. Name Home Phone Business Phone Name Address Home Phone Business Phor►e 20) Attach to this application a detailed description of the design, location and squsre 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. 22) Between what cross streets is business located? �' ��S �` � U,`c I'a/�� 4 Which side of street? N o y f' �i! 23) Are premises now occupied? �SWhat type of business? �e o a� f �-a s � 8t ey ANY FALSIFICATION OF ANSWERS GIVEN OR MP.TERIAL 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 MINN£SOTA) )ss. COUNTY OF RA."�SEY ) Subscribed and sworn to before me this �� 2� �t:,6.Z �rj rLQ Signature of Applicant / Date � day �l � ��2 ��Madl� 19 7 / r.i✓JV► ■ - 5` r'1 JONN C.MERRiII . ;� NO1AFttl PUBIICrMINNESOTA HENNEPIN COUIViY Notary Public 77' rHr/F � County, MN � MyCommt�o°EzpraJan. l2, 1997 a � My Commfssion expires � �