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HomeMy Public PortalAboutDoc_2010129 jaydeep-shell foodCity Manager v�ll.. Zoning (olive A Cyi il►1.�1i1«ii1 �1 I° W!1= Location Names (attach additional pages if necessary) �"G R RANTA a, PATEL Is business incorporated? es Names of landlord of the business location What other business is conducted at this location? Date of Birth toa c sub Pub Date 1\ 1 0 t o day of NOV b)6 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: LICENSE CLASSIFICATION Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited Retail Beer /Wine Sale by Drink for Consumption on Premises Only Retail Liquor Sale by Package Only, Consumption on Premises Prohibited Retail Liquor Sale by Drink for Consumption on Premises Only Retail Liquor Sale by Package Drink both in One Building under One Ownership Sunday Sales of Alcoholic Beverages Wholesale Beer Wholesale Liquor Wholesale Wine FEE 350 575 850 1,250 2,000 150 765 1,500 150 300 50 100 10 50 CHECK 100 Distiller, Brewer, or Manufacturer of Alcoholic Beverages Special Event Public or Private Property Beer, Wine (no current license) per event Special Event Public or Private Property Beer, Wine (no current license) 3 days Special Event Public or Private Property Beer, Wine (holding current license) per event Special Event Business Property Beer, Wine, Liquor (no current iicense) per event Special Event Business Property Beer, Wine, Liquor (no current license) 3 days Special Event Business Properly Beer, Wine, Liquor (holding current license) per event 1 n Name Business Nam Y LLB �3A NHL Poop MART ISIS euTLE AvE TYBEE AcNth CAA St Mailing Address p. (4S Phone q y BE Z�LAN1�,— 313 (G 12) 786 I Email N/A Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent (10 Interest in Business Home Addresses Has application been made for required State and Federal Licenses? `>i GS 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? i�1 0 o ever served time in prison or other correctional institution? N (°I o ever had an alcohol beverage license suspended or revoked at any time in any location? i" 0 (if answer is yes, give details) If this application is for RENEWAL of an existing license, enter License Number of existing license If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated? City, State, Zip aoG EAGLEt sT LAN e:TyRE-ems A ri 7 111 CRRss cREE Dt�rE PnoLER -3t3zz State of Incorporation Date Incorporated (c c R l` i/ /s. Address �VVA, Phone 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. I III/I1 i p s 1 Applicant Sig Approval Not ary Publ WHIM! My Commission Expires March 5, 2013 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. Social Security If yes, submit additional affidavit.