Fillable LAKE HAVASU CITY Application for Temporary Extension of (Lake Havasu City)

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LAKE HAVASU CITY Application for Temporary Extension of (Lake Havasu City)

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APPLICATION NUMBER DATE
Phone:
Email:
Phone:
Email:
Street Address:
Assessor Parcel ID: TRACT LOT
Description of Request:
Liquor Extension Yes No If YES, State Extension of Premise application is required.
a) Written permission from the property owner.
b) One 8-1/2" x 11" Site Plan including seating area and number of proposed seats.
c) Proof of Insurance (Certificate of Insurance).
d) State Extension of Premise application (if applicable).
a) Staff reviews submittal for completeness and compliance with the Lake Havasu City Code (3 business days).
b) Staff processes review, which includes multiple City departments (10 business days).
c) Staff mails original Notice of Action to owner and a copy to applicant (if different).
Permit Fee: Suspended per Resolution No. 20-3438 until the cessation of the Proclamation Declaring the Existence of a
Local Emergency
(7) CONTACT PLANNING FOR FURTHER INFORMATION
Luke Morris, City Planner (928) 854-0722 morrisl@lhcaz.gov
Stuart Schmeling, Development Services Director (928) 854-0714 schmelings@lhcaz.gov
(4) PROPERTY INFORMATION
(3) SITE LOCATION
BLOCK
(2) APPLICANT NAME/MAILING ADDRESS/CONTACT INFO (if different than Owner)
LAKE HAVASU CITY
Application for Temporary Extension of Outdoor Seating
Submit completed application to the Development Services Department / Planning Division:
2330 McCulloch Blvd N. / Lake Havasu City, AZ 86403 o
r
planninginfo@lhcaz.gov
To Allow for Adequate Social Distancing
(1) OWNER NAME/MAILING ADDRESS/CONTACT INFO
(8) CLARIFICATION
A person may request the City to clarify its interpretation or application of a statute, ordinance, code, or policy affecting the
processing of this application in accordance with ARS § 9-839.
(5) SUBMITTAL REQUIREMENTS: completed applicaton must include the following attachments:
(6) APPLICATION PROCESSING TIMEFRAME & FEES
1of2
12/08/2020
(CA12/08/2020)
a) I hereby file the above request as an authorized applicant.
b) To the best of my knowledge, the information provided herein is accurate and true.
c) If any information is incorrect, I understand this permit can be revoked.
d)
e) I am aware of the steps and timeframes involved in the processing of this application.
f)
g)
SIGNATURE DATE
Page 2 Application for Temporary Extension of Outdoor Seating To Allow for Adequate Social Distancing
(9) CERTIFICATION/ACKNOWLEDGEMENT
CONFIRM SIGNATURE
To submit this application electronically, Lake Havasu City requires that you certify your application by submitting an electronic
signature. Please type your name in the field below and click the confirm signature check box.
I understand failure to comply with conditions placed on this permit or the creation of a public nuisance as defined by applicable
state and local law may result in the immediate abatement of the offending activity or revocation of this permit.
Indemnification: To the fullest extent permitted by law, the owner and applicant agree to indemnify, defend, save, and hold
harmless Lake Havasu City, its departments, agencies, boards, commissions, officers, officials, agents, volunteers, and
employees (“Indemnitee”) for, from, and against any and all claims, actions, liabilities, damages, costs, losses, or expenses
(including, but not limited to, court costs, attorneys’ fees, and costs of claim processing, investigation and litigation) to which
any Indemnitee may become subject, under any theory of liability (“Claims”) arising out of or as a result of participation in the
temporary extension of premises outlined in this application. Participant agrees to be responsible for primary loss investigation,
defense, and judgement costs where this indemnification is applicable. This indemnification shall remain in effect so long as the
described extension of premises exists.
Insurance Requirements: I agree to purchase and maintain General Liability Insurance with the following requirements:
Minimum amount of $1,000,000 for each occurrence/$2,000,000 aggregate; coverage for bodily/personal injury, property
damage, and broad form contractual liability; endorsed to include Lake Havasu City, Arizona, its departments, agencies,
boards, commissions, officers, officials, agents, volunteers, employees, and contractors as named additional insureds with
respect to liiability arising out of or related to the occupancy, use, and activity in or about the lands described in this application.
The City must be notified within 10 business days of policy suspension, cancellation, and reduction in coverage or limits.
Insurance coverage must be provided by an insurance company admitted to do business in Arizona and rate A-VII or better.
2of2
12/08/2020
(CA12/08/2020)
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: _____/_____/______
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LAKE HAVASU CITY Application for Temporary Extension of (Lake Havasu City)

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Completed 23 January 2021

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