Application For Extension Of Premises/patio Permit - Arizona Department Of Liquor Licenses And Control

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DLLC USE ONLY
CSR:
Arizona Department of Liquor Licenses and Control
800 W Washington 5th Floor
Log #:
Phoenix, AZ 85007-2934
(602) 542-5141
APPLICATION FOR EXTENSION OF PREMISES/PATIO PERMIT
*
*
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?
N/A
Yes
No
If no, what is your estimated completion date? ____/____/_____
8. Do you understand Arizona Liquor Laws and Regulations?
Yes
No
9. Does this extension bring your premises within 300 feet of a church or school?
Yes
No
10. Have you received approved Liquor Law Training?
Yes
No
11. What security precautions will be taken to prevent liquor violation s in the extended area? ____________________________
___________________________________________________________________________________________________________________
12. IMPORTANT: 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.
1/25/2017
Page 1 of 2
Individuals requiring ADA accommodations please call (602)542-9027

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