Club License Caterer'S Permit - Alaska Alcoholic Beverage Control Board
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1CLUB LICENSE CATERER’S PERMIT
15 AAC 104.690
State of Alaska
Permit No.___________________________
Alcoholic Beverage Control Board
550 West Seventh Avenue, Suite 540
Anchorage, Alaska 99501
Fee Paid ____________________________
Phone (907) 269-0350
FEE $100.00
NOTICE TO APPLICANT: After approval by the appropriate law enforcement authority, send the completed form
along with the $100 non-refundable application fee to the Alcoholic Beverage Control Board. When the permit has
been approved, it will be returned to you for posting at the event. Within 48 hours after the event has ended, return
the posted copy to the Alcoholic Beverage Control Board. Failure to surrender the permit is cause for denial of
applications for permits made in the future by the permittee.
Name of Licensee(s)
Club License Number
Contact Person & Phone No.
Doing Business As
Location of Premises
Licensee’s FAX Number
Mailing Address (Street or P.O. Box, City, State and Zip Code)
The licensee named above hereby makes application under Alcoholic Beverage Control Board regulation 15 AAC
104.690 for permission to cater the event and temporary premises described below.
Event
Event To Be Held at: (Name and location of premise to
be licensed)
Purpose
Date of Event
Time of Event
I/We certify this written notice is submitted as required under 15 AAC 104.690 AND WILL BE RETURNED TO
THE BOARD WITHIN 48 HOURS AFTER THE EVENT HAS ENDED. Any person observed to be giving or
selling alcoholic beverages to a person under the age of 21 or a drunken person may be cited under AS 04.16.030,
AS 04.16.040, AS 04.16.050, AS 04.16.051, AS 04.15.052 or AS 04.16.060.
PRESIDING OFFICER _________________________________________________________________________
SECRETARY_________________________________________________________________________________
Approved
Disapproved
by: ___________________________________________Date__________________
Alaska State Troopers
OR______________________________________________Date___________________
Municipal Police Department
Reason Disapproved: ___________________________________________________________________________
_____________________________________________________________________________________________
This permit authorizes the licensee(s) of a club license to cater this event on the date and at the location requested
and the licensee(s) is hereby notified that any violation of any Alcoholic Beverage Control Board law or regulation
will be charged against the licensee). This permit will be issued unless a protest is noted by the appropriate police
authority, or if the Board finds that it would not be in the best interest of the public.
Approved
Disapproved
by_________________________________________Date_____________________
Alcoholic Beverage Control Board
Reason Disapproved: __________________________________________________________________________
INSTRUCTIONS:
Draw a detailed plan of the premises where the event will be held in the space below; show all
entrances and exits, and all fixtures such as counters, bars, coolers , stages, etc. Include the
dimensions of the premises. Outline in red the areas where alcoholic beverages will be sold,
served and consumed.
Rev. 12/26/00
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