City of Piedmont
Alcoholic Beverages Permit Application
Expires: Same date as the business’s ABLE Commission license
Please check all that apply for your business:
Small Brewer
Distiller
Winemaker
Small Farm Winery
Rectifier
Wine and Spirits Wholesaler
Beer Distributor
Retail Spirits
Retail Wine
Retail Beer
Mixed Beverage
Mixed Beverage/Caterer
Combination
On Premises Beer and Wine
Bottle Club
Caterer
Annual Special Event
Quarterly Special Event
Nonresident, Seller or
Manufacturer
Annual Public Event
One-Time Public Event
$125.00
$3,125.00
$625.00
$75.00
$3,125.00
$3,000.00
$750.00
$905.00
$1,000.00
$500.00
$1,005.00
$1,250.00
$500.00
$1,000.00
$1,005.00
$55.00
$55.00
$750.00
$1,005.00
$125.00
$3,125.00
$625.00
$75.00
$3,125.00
$3,000.00
$750.00
$905.00
$1,000.00
$500.00
$905.00
$1,250.00
$450.00
$900.00
$905.00
$55.00
$55.00
$750.00
$1,005.00
Owner’s Name: ____________________________________________________________________________
Name of Business: __________________________________________________________________________
Business Address: __________________________________________________________________________
Mailing Address: ___________________________________________________________________________
Business Type: _____________________________________________________________________________
Signature: ____________________________________________________ Date: _______________________
********************************** Office Use Only**************************************
□ Copy of Valid Driver’s License
□ Tax ID Number
□ Valid Business License
□ Valid License from the ABLE Commission
$________________________________________
Receipt Number: __________________________
Check Number: ____________________________
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