Fillable Form 1: (City of Phoenix)

Fill Online, Printable, Fillable, Blank Form 1: (City of Phoenix) Form

Use Fill to complete blank online CITY OF PHOENIX (AZ) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 1: (City of Phoenix)

On average this form takes 12 minutes to complete

The Form 1: (City of Phoenix) form is 2 pages long and contains:

  • 0 signatures
  • 15 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Phoenix

BROWSE CITY OF PHOENIX (AZ) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
4/20/2020 Page 1 of 2
Individuals requiring ADA accommodations please call (602)542-9027
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
Phoenix, AZ 85007-2934
www.azliquor.gov
(602
) 542
-514
1
*OBTAIN APPROVAL FROM LOCAL GOVERNING BOARD BEFORE SUBMITTING TO THE DEPARTMENT OF LIQUOR*
**Notice: Allow 30-45 days to process permanent change of premises**
Permanent change of area of service. A non-refundable $50. Fee will apply. Specific purpose for change:
_______________________________________________________________________________________________________________________________
Temporary change (No Fee) for date(s) of: ____/____/____ through ____/____/____ list specific purpose for change:
__________________________________________________________________________________________________________________________
______
1. Licensee’s Name: ________________________________________________________________________________License#: ___________________
Last First Middle
2. Mailing address: ______________________________________________________________________________________________________________
Street City State Zip Code
3. Business Name: _______________________________________________________________________________________________________________
4. Business Address: _____________________________________________________________________________________________________________
Street City State Zip Code
5. Email Address: ________________________________________________________________________________________________________________
6. Business Phone Number: ________________________________ Contact Phone Number: _______________________________
7. Is extension of premises/patio complete?
If no, what is your estimated completion date? ____/____/_____
8.
Do you understand Ari
zona Liquor Laws and Regulati
ons?
Yes No
9. Does thi
s extension bring your premises within 300 feet of a church or school
?
Yes No
10. Hav
e you received approved Liquor Law Traini
ng?
Yes No
11. What security precautions will be taken to prevent liquor violation s in the extended area? _____________________
_______
__________________
________________________________________________________________________________________________
_
12. IMPOR
TANT: Attach the revised floor plan, clearly depicting your licensed premises along with the new extended area
outlined in black marker or ink, if the extended area is not outlined and marked “extension” we cannot accept the
application.
DLLC USE ONLY
CSR:
Log #:
APPLICATION FOR EXTENSION OF PREMISES/PATIO PERMIT
4/20/2020 Page 2 of 2
Individuals requiring ADA accommodations please call (602)542-9027
I, (Print Full Name) ______________________________________________________, hereby swear under penalty of perjury and in compliance
with A.R.S. § 4-210(A)(2) and (3) that I have read and understand the foregoing and verify that the information and
statements that I have made herein are true and correct to the best of my knowledge.
Applicant Signature: _____________________________________________________
GOVERNING BOARD
DLLC USE ONLY
After completion, and BEFORE submitting to the Department of Liquor, please take this application to your local Board
of Supervisors, City Council or Designate for their recommendation. This recommendation is not binding on the
Department of Liquor.
Approval Disapproval
________________________________________________________________________________________________________________________
Authorized Signature Title Agency Date
Investigation Recommendation:
Approval Disapproval by: _________________________________ Date: ____/____/____
Director Signature required for Disapprovals: _____________________________________________________ Date: ____/____/____
Barrier Exemption: an exception to the requirement of barriers surrounding a patio/outdoor serving area may be
requested. Barrier exemptions are granted based on public safety, pedestrian traffic, and other factors unique to a
licensed premises. List specific reasons for exemption:

 Approval Disapproval by DLLC: _________________________________________________________ Date: _____/_____/______
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 1: (City of Phoenix)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 12 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document