Fillable Response to Covid-19 El Mirage Temporary Outdoor Dining (City of El Mirage)

Fill Online, Printable, Fillable, Blank Response to Covid-19 El Mirage Temporary Outdoor Dining (City of El Mirage) Form

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

Response to Covid-19 El Mirage Temporary Outdoor Dining (City of El Mirage)

On average this form takes 24 minutes to complete

The Response to Covid-19 El Mirage Temporary Outdoor Dining (City of El Mirage) form is 7 pages long and contains:

  • 1 signature
  • 15 check-boxes
  • 84 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of El Mirage

BROWSE CITY OF EL MIRAGE (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
 
PLANNING & ZONING DIVISION
Community Development Department
10000 N. El Mirage Road, El Mirage Arizona 85335
623-876-2996; Fax 623-876-4605; TDD 623-933-3258
www.elmirageaz.gov
Page 1
El Mirage Temporary Outdoor Dining Program -
Response to Covid-19
In response to the Governor’s Executive Order issued on December 3, 2020, to
allow restaurants in the State of Arizona to extend their outdoor dining area in
response to the Covid-19 pandemic, the City of El Mirage enacted a temporary
use permit program.
Temporary Use Permit
• A Temporary Use Permit Application and a $100.00 processing fee shall be
submitted to the Community Development Department Planning and
Zoning Division for processing. The Temporary Use Permit will be issued once
reviewed by the El Mirage Technical Advisory Members and inspected by
the El Mirage Fire Marshal.
• Restaurants with a current liquor license desiring to continue liquor sales
shall submit a temporary Application for Extension of Premises/Patio Permit
to cover the same expanded dining area to the Arizona Department of
Liquor License and Control.
• This program will be in effect for the duration of the Governor’s Executive
Order and all outdoor dining areas approved under this order shall be
removed.
Document Submittal
1. Application Form
2. A written Narrative description of how the temporary outdoor dining
area will:
a. Not occupy or impact the use of ADA facilities or public sidewalks.
b. Not eliminate required parking spaces.
c. Not block existing private or public driveways/accessways or drive
aisles.
d. Not block fire lanes, loading or unloading zones, or other
designated public safety areas.
3. Written authorization from the property owner authorizing use of the
expanded area.
El Mirage Temporary Outdoor Dining Program – Response to Covid-19; Continued
Page 2
4. A site plan/sketch depicting the proposed outdoor dining area layout
with dimensions. Note that any structures (i.e. tents and fencing) being
constructed in conjunction with this temporary permit will require a
building permit. If structures are part of the plan, submit a site
plan/sketch showing interior and exterior dimensions and occupancy
loads, structure dimensions, construction materials and anchoring
information.
5. If the request is to allow alcohol consumption in the expanded dining
area, include a copy of the temporary Application for Extension of
Premises/Patio Permit submitted to the Arizona Department of Liquor
License and Control; and;
6. A current aerial photograph of the subject property with the temporary
outdoor dining area delineated.
Check List
Permit Plan Review Application
Narrative
Property Owner Authorization Letter
Site Plan
A copy of the Arizona Department of Liquor License and Control
Application for Extension of Premises/Patio Permit (If Necessary)
Current Aerial Photograph
Please visit the Arizona Department of Health Services for the latest on restaurant
social distance guidelines at www.azdhs.gov.
I swear or affirm that the documents submitted to be true:
Applicant’s Signature: ________________________________________Date: __________
Name of Business: ____________________________________________________________
Please contact Jose A. Macias, City Planner, Community Development
Department – Planning and Zoning Division for additional questions at
jmacias@elmirageaz.gov or 623-876-2996.
CITY OF EL MIRAGE
Building, Engineering,
Fire, Planning
13601 N. El Mirage Rd.
El Mirage, AZ 85335
Phone (623) 583-7968
Fax (623) 583-8257
OFFICIAL USE ONLY
Permit No.:
Plan Review Fee/Deposit: (if applicable)
Total Permit Fees: (Balance due)
PROJECT ADDRESS: Submittal Date:
PROJECT NAME: Lot or Suite:
Subdivision Name: APN# Valuation:
Description of Work:
TYPE OF PERMIT:
_
____COMMERCIAL BLDG _____ RESIDENTIAL _____ ENGINEERING _____FIRE ALARM/SPRINKLER
_____T
ENANT IMPROVEMENT _____ ADDITION/PATIO _____SIGN _____ OTHER:____________________________
APPLICANT/CONTACT:
Phone:
Address: e-mail:
City: State Zip code
OWNER:
Phone:
Mailing Address: e-mail:
City: State: Zip Code:
CONTRACTOR:
Phone:
Address: e-mail:
City: State: Zip Code:
El Mirage Business License # AZ Tax ID # ROC #
The undersigned, under penalty of perjury, does hereby certify that all improvements made to the above project, at
the address as stated above, by means of the building or improvement of structures or appurtenances of such property will be
performed by a duly licensed contractor unless the entire structure is intended for the undersigned’s sole occupancy.
I understand owners who sell or rent property with improvements not completed by a licensed general contractor,
may be subject to a Class 1 Misdemeanor under Arizona Revised Statutes §32-1151 and §32-1154. A Class 1Mis-
demeanor is punishable by a fine not to exceed $2,500 and /or one year in the County Jail. I understand and acknowledge
the above certification.
O
wner/Applicant_________________________________________________________Date______________________
“quality community development through quality customer service”
PERMIT/PLAN REVIEW APPLICATION
click to sign
signature
click to edit
Community Development – Zoning & Zoning Division – 10000 N. El Mirage Road, El Mirage, Arizona 85583 – 623-876-2996
This and other forms can be found on our website:
www.elmirageaz.gov/770/Planning-and-Zoning
Revised 12/07/2020
If fencing or other structures are planned in conjunction with this temporary outdoor dining use, include a site
plan/sketch of the interior and exterior of the property with dimensions noted. A building permit will be
required. Building permit fees must be paid.
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: _____________________________________________________
GOVERN
ING BOARD
DLLC USE ONLY
After comple
tion, 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

Response to Covid-19 El Mirage Temporary Outdoor Dining (City of El Mirage)

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 22 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document