HomeMy Public PortalAboutDoc_2010129 northbeach bar grillLICENSE CLASSIFICATION
FEE
CHECK
Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited
350
Names (attach additional pages if necessary)
Retail Beer /Wine Sale by Drink for Consumption on Premises Only
575
City, State, Zip
Retail Liquor Sale by Package Only, Consumption on Premises Prohibited
850
Retail Liquor Sale by Drink for Consumption on Premises Only
1,250
a
to
Retail Liquor Sale by Package Drink both in One Building under One Ownership
2,000
Sunday Sales of Alcoholic Beverages
150
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Wholesale Beer
765
a
Wholesale Liquor
1,500
Wholesale Wine
150
Distiller, Brewer, or Manufacturer of Alcoholic Beverages
300
Special Event Public or Private Property Beer, Wine (no current license) per event
50
Special Event Public or Private Property Beer, Wine (no current license) 3 days
100
10
Special Event Public or Private Property Beer, Wine (holding current license) per event
Special Event Business Property Beer, Wine, Liquor (no current license) per event
50
Special Event Business Property Beer, Wine, Liquor (no current license) 3 days
100
Special Event Business Property Beer, Wine, Liquor (holding current license) per event
10
Business Name 1.4.0414. 15 4 L 2..t Lt...
Location ;g 1h `Dec r t: r 1 e o. A it 2�c
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Mailing Address 1 1 0 iv To I1-i £kvGt.1J/1S4 t ,I s( 4-a4
Phone {12l fl f_ r I i ri r! Email i& (2- 1� A- fk
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Names and Home Addresses of Owners, Partners or Corporate Of with Ten Percent (10 Interest iin �siness
Names (attach additional pages if necessary)
Date of Birth
Home Addresses
City, State, Zip
Social Security
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CITY OF TYBEE ISLAND
ALCOHOL LICENSE APPLICATION
Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic
beverages as indicated below:
Notice: The applicant
for a license shall be a
citizen of the United
States, a resident of
Chatham County, and
owner of the business
or if a corporation,
partnership or other
legal entity is the
owner, a substantial
and major stockholder
or the applicant may be
the manager of the
business charged with
the regular operation of
said business on the
premises for which the
license is issued.
1
Is business incorporated? State of Incorporation f c tr t 4 Date Inrpora e 6 I /Zb 1 O
Names of landlord of the buss location 61 C imbCG Address rev S I AA Phone a 1 Z, 7gto 1 .6'73
What other business is conducted at this location. �Aj 1
Has application been made for required State and Federal Licenses?
Has applicant, any person connected with, or any person having an interest in this business:
o ever been convicted of any violation of law other than for a traffic violation? j J 0.
o ever served time in prison or other correctional institution? PO
o ever had an alcohol beverage license suspended or revoked at any time in any location?
Of answer is yes, give details) �11Li Y�SW2 5A-1,2,- i+ �Jcc t
If this application is for RENEWAL of an existing license, enter icense Number of existing license 41 I7 1
If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated?
ALL OF THE FOREGOING INFORMATION IS HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH
WILLFULLY, KNOWINGLY, AND ABSOLUTELY, AND THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW.
Applicant Signature
ubscribed,ffore m
17 124
day of Jki 0 V 20 g;
EORGE B. BARGE
Notary Public, Chatham County, GA i
My Commission Exp
Date
Approval
If yes, submit additional affidavit.
Signature Date
City Manager
Zoning
Police
City Council
/1/16 /P