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DLLC USE ONLY TEMPORARY EXTENSION OF Tob # PREMISES/PATIO PERMIT Date Accepted: A non-refundable $100 fee will apply eee Arizona Department of Liquor Licenses and Control 800 W. Washington St. 5" Floor Phoenix, AZ 85007 (602) 542-5141 APPLICATION DUE TO THE LOCAL GOVERNING BODY 60 DAYS BEFORE DELIVERY TO THE DEPARTMENT OF LIQUOR APPLICATION MUST BE SUBMITTED TO THE DEPARTMENT OF LIQUOR 30 DAYS PRIOR TO FIRST SCHEDULED DATE A.R.S. § 4207.03 license#: olao 1002008 ’ 1. AgentName:___ Peterson. Pindcea Je Last First Middle 2. Business Name: AS!s Co-o0@ Gei\\ 3. Business Location Address: 19300 ©. old US Hoy YO Ack aglen Az $5322 Clty BS _, Street ; AI z loZ.3- 399-2131 Contact Phone Number 4, Business Phone Number: 5. Mailing address: 6. Email Address: 7. Specific purpose for change: We ign 8. Does this extension bring your premises within 300 feet of a school? Lyes FANo Dates of the Temporary Extension — Must not exceed 6 months. Date Day of Week Start Time End Time 11724 Sokucdag [Pon Liam (Aitach additional sheet if necessary) MODIFICATIONS TO DATES AND TIMES ONLY, USING THE SAME EXTENDED DIAGRAM OF PREMISES, ARE ALLOWED. REQUIRES A 10 DAY ADVANCE NOTICE TO THE DEPARTMENT OF LIQUOR FOR APPROVAL. T1V/TAINNGD Pace 1 nf? REQUIRED ATTACHMENTS 1. MUST submit a security plan and identify security measures that will be implemented in order to: ° Provide for the safety of the patrons. ° Ensure anyone under legal drinking age does not purchase, possesses, or consume alcohol. e Prevent unauthorized removal of alcohol from the extended premises. e Prevent unauthorized carrying of alcohol onto the extended premises. 2. MUST attach a diagram, clearly depicting your licensed premises along with the new extended area, ifthe extended area is nof outlined and marked "extension" we cannot ac the application, BARRIER oO 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 fo a licensed premises. List specific reasons for exemption: Cc Approval O Disapproval by DLLC: SIGNATURE Declaration: |, (Print Name) Andrea Yo Pelecson declare under penalty of perjury that | am authorized to submit this application. | have read the contents of this application, and to the best of my knowledge believe all statements made on this application to be true, correct and complete. ‘7 7 Signature GOVERNING BOARD After completion, and at least 60 days BEFORE submitting to the Department of Liquor, please take this application fo your local Board of Supervisors, City Council or Designate for thelr recommendation. This recommendation Is not binding on the Department of Liquor. Date Received: Agency: Decision Date: Title: C1 Approval D1 Disapproval Authorized Signature: DLLC USE ONLY Investigation Recommendation: FJ Approval [1] Disapproval by: Director Signature required for Disapprovals: 11/14/2023 Pase 2. of ? License # 012070020086 Licerise type: 12 Arlington Grill LLC. 18300 S. Old US HWY 80 Arlington, AZ 85322 Hours: 10am-10pm Sunday-Thursday Friday-Saturday: 10am-lam Closed Mondays! This is A.J’s Co-Op Grill request for a temporary extension of pramises on 12/7/2024, trom 4pm to 1 AM the following day. We wili be fencing oif our parking tot to provide one entrance that will be monitored by the charity’s security, who will be checking customers’ |.D2s, handing out wrist bands and guiding the overail atrnosphere of the event. The blus highlighted section on the attached diagram is the section that will need tie extension. aged. DesertiRose dy avesen|Roseltis Securit Plan. Dec. 7th Boar From UY em Jam we vo \I De hosting o wike wight. of A, ».'S Coe? Geil), Thee will pe Secudty on Bike provided by the organization, We will we providing wrist buds €or Over “a” and Cerd'ay ar +e door. shee and mysele overseeing od Ye T wil) hex Checing do malee sucé everything te People erkeriney 1S ANG Smoothly . anc MI Ps— Whial24