Adopted by the City of Beaumont 2014
CITY OF BEAUMONT
RENEWAL APPLICATION FOR ALCOHOLIC BEVERAGES PERMIT
Applicant: Applicant must submit all prescribe fees with completed applications.
Type of Permit(s) applied for: ________________________________________________________________________________
Application Date: _____ / _____ /_____
LEGAL OPERATOR(S) INFORMATION
Print full name(s) of legal operator(s):
_____________________________________________________________________________________________________________________
Last First Middle Initial Suffix Date of Birth Social Security No.
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Last First Middle Initial Suffix Date of Birth Social Security No.
_____________________________________________________________________________________________________________________
Last First Middle Initial Suffix Date of Birth Social Security No.
(If additional space is necessary use a separate sheet)
Hereby make application to operate doing business as:
_____________________________________________________________________________________________________________________
Name of Business Street Address Zip Code
_____________________________________________________________________________________________________________________
Operator’s Phone Number (24 hour access) Driver’s License or Identification Number Operator’s E-mail Address
Has this business ever operated under a different Trade Name: Yes No (Check One.) If yes, complete the following:
_____________________________________________________________________________________________________________________
Name of Business Previous Trade Name
Are you the legal owner of the property? Yes No (Check One.) If no, complete the following:
_____________________________________________________________________________________________________________________
Property Owner’s Name Street Address Zip Code
_____________________________________________________________________________________________________________________
Property Owner’s Phone Number Property Owner’s E-mail Address
Is this an existing business that is changing locations: Yes No (Check One.) If yes, complete the following:
_____________________________________________________________________________________________________________________
Name of Business
_____________________________________________________________________________________________________________________
Previous Address City State Zip Code
Primary Business: ______________________________________________________________________________________________________
Will your establishment have gaming machines? Yes No
Will your establishment have sexually oriented entertainment? Yes No
In full compliance with the ordinance provision of the City of Beaumont Code of Ordinances, Chapter 6 which regulates the conduct of such
places, I hereby certify that I fully understand and agree that such permit may be revoked in the event this facility is not operated in accordance
with the state law and local ordinance. I am applying for the renewal of an alcoholic beverage permit and certify that all information submitted
in this application is true and correct, and that there have been no material changes in the business, such as ownership. I understand that any
false or misleading information shall cause my application to be denied; my permit revoked, and subjects me to criminal prosecution.
Signature(s) ___________________________________________________________________________________________________________
