ANACAPA GRILL AT CORTE BELLA_REDACTED.PDF

DLLC USE ONLY

PERMANENT EXTENSION OF opt

PREMISES/PATIO PERMIT Date Accepted:

A non-refundable $50. fee will apply CSR:

Arizona Dept. of Liquor Licenses and Control
800 W. Washington St. 5"" Floor Phoenix, AZ 85007
(602) 542-5141

Type or Print with Black Ink

*OBTAIN APPROVAL FROM LOCAL GOVERNING BOARD BEFORE SUBMITTING TO THE DEPARTMENT OF LIQUOR*
**Notice: Allow 30-45 days to process permanent change of premises**

12077469

Addition to the existing kitchen for additional storage and cooler;

License#:

Specific purpose for change:

addition of storage room to front of social hall rooms

1. Agent/Individual Name: Anderson Ryan Witner

Last First Middle
2. Premises Name (Doing Business As-DBA): Anacapa Grill at Corte Bella

3. Premises Location Address:

22135 N Mission Drive Sun City West AZ 85375

State Zip Code

4. Mailing address:

State Zip Code

5. Email Address:

6. Business Phone Number: 623/328-5068 Contact Phone — |

7. \s extension of premises/patio complete?

202:
Onva Dyes] No If no, what is your estimated completion date? 12 i 31 / 2

8. Do you understand Arizona Liquor Laws and Regulations?

[Yes LINo

9. Does this extension bring your premises within 300 feet of a church or school?

Lyes WINo

10. Have you received approved Liquor Law Training?

[Yes LNo

11. What security precautions will be taken to prevent liquor violation s in the extended area? This addition is
extending the footprint of the building to add a storage and cooler room to the kitchen.

The kitchen extension will not affect service to the public.

7/21/2022 Page | of 2
Individuals requiring ADA accommodations please call (602)542-2999 (480247)

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.

BARRIER

(1 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:

n/a

O Approval 1  Disapproval by DLLC:

SIGNATURE

Declaration:

|, (Print Name) Ryan Witner Anderson, Agent , declare pnder penalty of perjury that | am
authorized to submit this application. | have read the contents of t¥s application, and to the best of my
knowledge believe all statements made on this application to be true, Zorregt and complete.

we

V Signature——~

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.

O Approval D1 Disapproval

Authorized Signature Agency

DLLC USE ONLY

Investigation Recommendation: 0 Approval C1 Disapproval by:

Director Signature required for Disapprovals:

7/21/2022 Page 2 of 2
Individuals requiring ADA accommodations please call (602)542-2999

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