HomeMy WebLinkAboutItem 16 Liquor License Application for Mohawk Chevron
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AGENDA ITEM SUMMARY
SPRINGFIELD
CITY COUNCIL
September 17, 2007
Regular Session
Developm~
Dave PuentJiV~
726-3668 y}r
Consent Calendar
ITEM TITLE:
ACTION
REQUESTED:
ISSUE
STATEMENT:
ATTACHMENTS:
.DISCUSSION/
FINANCIAL
IMPACT:
LIQUOR LICENSE APPLICATION FOR MORA WK CHEVRON.
Endorsement of OLCC Liquor License application for Mohawk Chevron, located at
1111 Mohawk Blvd., Springfield, Oregon.
The owner of Mohawk Chevron has requested the City Council to endorse his
OLCC Liquor License Application.
Attachment 1. OLCC Liquor License Application
The license endorsement for Mohawk Chevron is for a new outlet with Off-
Premises Sales with Fuel Pumps. The license application has been reviewed and
approved by the appropriate City Departments.
OREGON LIQUOR CONTROL COMMISSION
LIQUOR LICENSE APPLICATION
PLEASE PRINT OR TYPE
Application is being made for:
LICENSE TYPES
Cl Full On-Premises Sales ($402.60/yr)
Cl Commercial Establishment
Cl Caterer
Cl Passenger Carrier
Cl Other Public Location
Cl Private Club
o Limited On-Premises Sales ($202:60/yr)
~ Off-Premises Sales ($100/yr)
~ with Fuel Pumps
o Brewery Public House ($252.60)
o Winery ($250/yr)
o Other:
Apolying as:
Cl Individuals Cl Limited * Corporation
Partnership
{. (,.....'.-..---.......0
~
':7 00 7 () q:2../
.Do--
............................
. .,.
.. .
ACTIONS
o Change Ownership
~ New Outlet
o Greater Privilege
o Additional Privilege
o Other
FOR CITY AND COUNTY USE ONLY
The city council or county commission:
(name of city or county)
recommends that this license be:
Granted 0 Denied 0
By:
(signature) (date)
Name:
Title:
OlCC USE ON~
Application Rec'd by: #/1' .
. ,
Date: 7h::Z/l? .
I
90-day authority: 0 Yes Cl No
o Limited Liability
Company
1. Applicant(s): [See SECTION 1 of the Guide]
Q) 7Z4 gc.ST ~/V"'h;;d'7'eN? ...d."" @
@ @
2. Trade Name (dba): 4'?'&,~...q-h- /c.
L,-H L:::iJ,./".AE DA/
3. Business Location: /. ./ / /..../ ~'-<'7--' j/V...c
(number, street, rural route)
~.J2.;//;I9~/L.rz L:>
(city) (county) (state)
bJAlL$ e;e 97Yl7
(ZIP code)
4. Business Mailing Address: IJb. Bc:.rx. 76.SC 7
(PO box, number, street, rural route)
5. Business Numbers: (s 1//) 3 q 9 c2 L(' /; l
(phone)
6. Is the business at this location currently licensed by OLCC? DYes raNa
7. If yes to whom:
C-UC'.".<s AJG
(city)
9 -, \<'!6 J
(ZIP code)
.:V'/ ~3.
~~
(state)
CSe//J 3 "'9
(fax)
Type of License:
8. Former Business Name:
9. Will you have a manager? ~Yes ONa Name: L u '/ ,;:::::., . 11-' .4 ~ dl
(manager must fill out an individual history form)
11. Contact person for this application: Lv T ;.;i
(name)
10. What is the local governing body where your business is located?
(name of city or county)
[54 J) ~ blf--L/ s-<:;' S'
(phone number(s)
-
.I 1~4~tIT
(address) (fax number) (e-mail address)
J understand that if my answers are not true and complete, the OlCC may deny my license application.
Applicant(s) Signature(s) and Date:
-?/---c ./
:~?f'
Date 0~,J;7 @
/' '" .
Date
Date
@
Date
I
ATTACHMENT 1 .