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DLLC USE ONLY Arizona Department of Liquor Licenses and Control CSR: 800 W Washington 5th Floor Phoenix, AZ 85007-2934 Log #: www.azliquor.gov (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 premise** E Permanent change of area of service. A non-refundable $50. Fee will apply. Specific purpose for change: To Walk outside into the fenced Area with Alcoholic Beverage Temporary change (No Fee) for date(s) 02 01 /17 through °2 // 17 list specific purpose for change: 1. Licensee's Name: Yousif Danny License#: 06070505 2. Mailing address: State Zip Code 3. Business Name: Tin Top Bar & Grill 4. Business Address: 37901 W. Salome Hwy Tonopah AZ 85354 Street City State Zip Code 5. Email Address: 6. Business Phone Number: 6233861501 Contact Phone Number: 7. Is extension of premises/patio complete? ON/A rilYes0No If no, what is your estimated completion date? / / 8. Do you understand Arizona Liquor Laws and Regulations? I,, Yes P No 9. Does this extension bring your premises within 300 feet of a church or school? Ekes CSIINo 10. Have you received approved Liquor Law Training? it° Yes El No 11. What security precautions will be taken to prevent liquor violation s in the extended area? One Entrance/ Exit under Staff Supervission 12. IMPORTANT: Attach the revised floor plan, clearly depicting your licensed premise 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. 2/23/2016 Page 1 of 2 Individuals requiring ADA accommodations please call (602)542-9027 El 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 premise. List specific reasons for exemption: ElApproval aisapproval by DLLC: Date: /_/ Notary I. (Print Full Name) Dei,_ v V 0 ) , hereby declare that I am a CONTROLLING PERSON/ AGENT filing this notification. I have read this document and the contents and all statements are true, correct and complete. X (Signature) State of An 2._( 0-1 County of Ma- Pr coil Controillfig Person / Agent the foregoing instrument was acknowledged before me this THOMAS E. CHO WAN of /V( L ,9ra My commission expires on: Notary Public - Arizona Month Year Maricopa County My Comm. Expires May 31, 2019 SIgnalvre oaCefARY PUBLIC GOVERNING BOARD 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. 0 Approval Disapproval Authorized Signature Title Agency Date DLLC USE ONLY Investigation Recommendation: 0 Approval 0 Disapproval by: Date: Director Signature required for Disapprovals: Date: 2/23/2016 Page 2 of 2 Individuals requiring ADA accommodations please call (602)542-9027 Proposed area is fenced in with 6 foot chain link fence