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nn -Premise Prequalification Packet L -ON <br />MW (0912013) <br />`-Please coin ,leEe.this:Pre uglification Packet::with:anformation:conc [Win :' our:' io S!Fib!3 10 <br />T, .1010 00 A <br />proper governmental qqs:' ro; r.% <br />t your proposed location is legal forthe;type of licenselpermit fob you are applying :::; <br />. <br />e T Ut..X .'60 U <br />to F0. f - <br />. . <br />.9 <br />I e of On -Premise License/Permit <br />JWBG <br />Wine and Beer Retailers Permit El LB Mixed Beverage Late Hours Permit <br />❑ BE Beer Retail Dealer's On -Premise License ❑ MI Minibar Permit <br />❑ BL Retail Dealers On -Premise Late Hours License ❑ CB Caterer's Permit <br />C] BP Brewpub License ❑ FB Food and Beverage Certificate <br />0 V Wine & Beer Retailer's Permit for Excursion Boats E] PE Beverage Cartage Permit <br />El Y Wine & Beer Retaller's Permit for Railway Dining Car [:1 RM Mixed Beverage Restaurant Permit with FB <br />[I MB Mixed Beverage Permit <br />2. IrWicate Primary Business at this Location <br />Restaurant [:] Sporting Arena, Civic Center, Hotel <br />Bar F1 Miscellaneous <br />E] Sexually Oriented <br />3. Trade Name of Location <br />7B D' W!�3. tG- <br />---C,6 <br />4. <br />4. Location Address I <br />City County A State Zip Code <br />-LAA Cmv- 5 <br />5. Mailing Address City Stto Zip Code <br />t K)Z3 -5 YOpa A— C— __V_:k_ 55 <br />6. Business Phone No. Itemate Phone No. -ma Address <br />7 6E <br />w <br />7. T e of Owner <br />T Individual Corporation El City/County/University <br />El Partnership [I Limited Liability Company E] Other <br />El Limited Partnership F-1 Joint Venture <br />D Limited Liability Partnership[] Trust <br />8. Entity/ApplicAlt <br />.011dant IsIMUst. a <br />IndiVldu­'aI1ln'div1d6a'I Owner':.` L m1s-pahVIAll Offic <br />PartfidirthiplAIE oln - entdre/Verftij rer- <br />mit6d Partners rusta <br />'ti' bip/All Geniar6l. Pa'thiers -r*u'it7de7c��)..—..,-...,—..,.:.t 7- <br />oration/All Officers::: -C' Univers" <br />:Cft�;" ountV,Un"' Woffibia <br />Last Name First Name <br />MI Title <br />_D <br />Last Name <br />IA, <br />First Name <br />MI <br />Title <br />S \j <br />C pn:�- <br />::s <br />2' 0 <br />Last Name <br />First Name <br />MI <br />Title <br />Page 1 of 5 Form L -ON <br />