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DLLC USE ONLY PERMANENT EXTENSION OF} [2° | p 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** 14070081 License#: i Expansion of patio to provide more sunlight seating during winter months Specific purpose for change: p p p 8 g 8 Daniel James Richard 1. Agent/Individual Name: Last First Middle 2. Premises Name (Doing Business As-DBA): Kellis Draper American Legion Post 12 176 N Frpmtoer St. Wickenburg Arizone 85390 3. Premises Location Address: Street City State Zip Code 4. Mailing address: 176 N Frontier St Wickenburg AZ 85390 Street City State lip Code 5. Email Address: #mericanlegionpost | 2az@gmail.com 928 684-7762 602 980-7444 6. Business Phone Number: Contact Phone Number: 7. \s extension of premises/patio complete? 03 #15 2026 Ona 0 Yes 3 No If no, what is your estimated completion date? Jf 8. Do you understand Arizona Liquor Laws and Regulations? Byes ONo 7° Does this extension bring your premises within 300 feet of a school? OyYes BNo 10. Have you received approved Liquor Law Training? Byes ONo 11. What security precautions will be taken to prevent liquor violation s in the extended area2 Controlled acess and fence enclosing patio 10/03/2022 Page | of 2 Individuals reauirina ADA accommodations please call 6021542-2999 12. IMPORTANT: Atiach 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 ouflined and marked “extension” we cannot accept the application. BARRIER QO 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: Expension of patio for winter searing in sunlight C Approval O Disapproval by DLLC: SIGNATURE Declaration: i James richard Daniel . 1, (Print Name) . 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. . 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. D Approval O bDisapproval Authorized Signature Title Agency DLLC USE ONLY Investigation Recommendation: 0 Approval 11 Disapproval by: Director Signature required for Disapprovals: 10/03/2022 Page 2 of 2 Individuals reavirina ADA accommodations please call 16021542-2999