TIN TOP BAR & GRILL_REDACTED.PDF

DLLC USE ONLY

Arizona Department of Liquor Licenses and Control Ae
800 W Washington 5th Floor are
Phoenix, AZ 85007-2934 ia

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 premises**

(1 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:a.<2/.0| /22) through 0,2 /.24/<2.Jist specific purpose for change:

Yousif Danny 06070505

1. Licensee's Name: License#:

Street City State Zip Code
3. Business Name: Tin Top Bar & Grill
Business Address: 37901 W Salome Hwy Tonopah AZ 85354

5. Email Addres:
6. Business Phone Number,0233861 901 Contact Phone — lc tle

7. Is extension of premises/patio complete?
N/A [1 Yes LI No If no, what is your estimated completion date? / /

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?

CYes [INo

10. Have you received approved Liquor Law Training?
Yes LINo

11. What security precautions will be taken to prevent liquor violation s in the extended area? One Entrance/Exit under

Staff supervision

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.

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Individuals reavirina ADA accommodations please call (602)542-9027

C1 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:

DApproval [1] disapproval by DLLC:

|, (Print Full Name). amy MAS A hereby swear under penalty of perjury and in compliance
with A.R.S. § 4-210(A)(2) and (35 that | have read and understand the foregoing and verify that the information and
statements that | have made herein are true and correct to the best of my knowledge.

a

ae )
Applicant Signature: ( _\ CNL 4 Vv aa
ao Cc

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 01 disapproval

Authorized Signature Agency

DLLC USE ONLY
Investigation Recommendation: J Approval 11 disapproval by: Date: / /
Director Signature required for Disapprovals: Date: | a

4/20/2020 Page 2 of 2
Individuals reauirina ADA accommodations please call {602]542-9027

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