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x "48XA' M"01101IC <br />r r as a�aa "raarr <br />ON -PREMISE P LIP'IC ,TI C E T L -ON <br />(12/2017) <br />Submit this packet to the proper governmental entities to obtain certification for the type of license/permit for i <br />which you are applying as required by Sections 11.37, 11,39, 11,46(b), 61.37, 61,38, 61.42 and Rule §33.13 <br />Contact your local T BC office to verify requirements of Sections 11,391 and 61.391 as you may be required to <br />post a sign at your proposed location tit} -days prior to the issuance of your licenselpermit. <br />a a�tYrlrrIP.-alid cat) cilac1 in the Texas A/colcia, Beverage <br />dodeorRules lucaled on our webstuwvnv,�tab c.txas�av1,1awIsIcadeard rules. <br />T'I INF ORMATION, <br />1, Application for: i-➢ Original Add Late Hours Only License/Permit Numbed:_ <br />I_ Roinstaternent License/Permit Nurrtber <br />C t". hange of Licensed Location LicenseiPermit Nuli,iibler_ <br />2. "l'ype of On -Premise Licensel'Perrnit <br />C, .9 B i ka il'ae i.'lad L-areer 1'"'kw%i.iNlear`5 Permit LB mixeri, Beverage Late HokrJ1 b t"Ornlit <br />E Meer Retail Demers On-Preimse License lrr'tl Mini'dar Permit <br />91- Retail Dealer's tura-Pienaase Late Hours L'iconse El CB Caterter's Permit <br />G� <br />BP Brc wtauta License FB Food and Beverage 4 eifitic;-ats <br />[� V Wine & Beer R et;,ailw's POrrrlit for Excursion Boats FPE Beverage C rarta9e f errnui <br />Y VVne & BeerRetaajker's Permit for Railway mining t;aa" E] FSM Mixed Bpvprrage Restaurant Permit with f13 <br />L <br />JWB Mixed Beverage Permit <br />1mm 0 Private h'arrier's 1='erinit — For Grewpulas (U) with a BG only <br />. Indicate Primary Business at this Location <br />RestaWant Sporting Frena, Civic Center, Fidel far <br />..� Grocery/Market Sexra�ally OrientCKI Miscellaneous <br />41, Trade (dame of Loca ion <br />Aroma's Italian Grill <br />5. Location Address, <br />1023 S Broadway <br />City County _ State Zip Code <br />La polle Harris TX 77571 <br />. Mailing address City State i Zip Code <br />Sarne as Above <br />7. Business Phone No. Alternate Phone No E-mail Address <br />28194142.57 i done genci_k@llotmail.com <br />OWNER INFORMATION—— <br />. Type of Owner <br />_ Individual <br />Corporation �.� Cityl raur7'tyltJniversity <br />Partnership Limted Liability Company F] Other <br />Limited Partnership Joint Venture <br />Limited Liability Partnersdtra � Trust <br />9. Business Owner/Applicant <br />Lrrnir M TALIAJ <br />101. Are you, the applicant a veteran -owned business? UYes, No <br />A1. Are you, the applicant a Historically Undeaklized Business (HUB)? 0Yes No <br />Page t of 5 Form L -ON (12/2017) <br />