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HomeMy WebLinkAboutBusiness License Application 1986-3-19 Date Issued , OREXn'l LIQUOR ,-VN.l<VI.. CQMMISSIct'l ::;t'l:L.1l\L DISPENSER LICENSE APPLICATIct'l UKJ:U)J.~ LIQUOR ,-",n<vI.. CQMMISSIct'l P.O. BOX 22297, PORTLAND, uKJ:U)J.~ 97222 Appl:Lcatl.on 15 hereby made for a Specl.al D15peIlser Ll.cense . . . . $25.00 per day (Appll.cant holder of D15peIlser Class A X. Class B or Class C Ll.cense.) (Check one of the atove) - Hours of sale are from 7:00 AM to 2:30 AM. Ll.cense may not exceed 5 days. Lnclosed l.S a check or noney order m the anormt of $ as full payment. Fee wl.ll be refrmded l.f l:Lcense l.S deIued, otherwl.Se l.t wl.ll not be refrmded. 1 . Appl:Lcant: US-U.) \ 'S -+ -e..... 'L \\ t: ,A ~~c.... 2. Trade Narre: ~~\ > '.relephone No. 3. Ma:Llmg Address: , C; 0 <; LU L ~ f (tV: ~ (Number) (Street) (Cl.ty) 4. Event: W~ i/_k..~~ ~~ f) ~ i--k:",yL. 5. person(s) responsJ.ble: ~e-ILil:I ~ ~""C~<">-iS...:::::, ~ W '0-\ 1t,"J L lNarre) \?' (BusmesS tele.]2.hone) Meress: I~! C ~ L\J ( ."t:2.-- fJ7 L-<- t-.-/ ') 1<( 0"2- t., 0 (:J- I '7 <7 0 (Number) (Street) (Cl.ty) (Zl.p) (Home telephone)' 6. SYo!ct locatl.On of pr6ffiLSr for~uch l1c~se ~appl:Led: L /7/7 ~.". / S-J..v~,~~f..,/ ~...-<.- lNumberJs<,\i-c:. ~eet) -/ (Cl.~) iL:l.p; (cormty) 7. A'::xJve locatl.On l.S: :>L Wl.thm Cl.ty l:uruts Outsl.de Cl.ty l:uruts (Check one) ;4)('~1 f 4 -I" 7 ;;L(d'lC)"32- 0"7lfO L- (Zl.p) 8. O)ate or dates of event: 10 /lq~G I 10. Who Wl.ll recel.ve the profl.ts from thl.S ll.cense: " ExpeCted attendance: ISw~ I~O 9. Hours of operatl.on: '1. Ijwe rmderstand that a false answer to any of the foregomg questl.Ons Wl.ll subject th15 appl:Lcatl.On to denl.al. Ijwe cert1.fy that all mforrnatl.On sulnutted l.S complete and correct to the best of ~jour knowledge. i2. Ll.censees holdmg a D15peIlser Class A, B or C Ll.cense rmderstand that saLd ll.cense 1S S..:DJect to suspensl.on or revocatl.on l.f cause rmder ORS 47~.180~1 ar m connec- tl.OTI W1th the specl.al l:Lcense appll.ed for. Sl.gnature: "r?;, ,L~ . (V" . Sl.gnature: Date: ~ - I (( - '10 CCJMPLI:;l'tD AND W!.AJt<SED APPLICATIct'lS MUST BE RECEIVED BY OUX 10 DAYS PRIOR 'lD DATE OF EVENT THAT APPLICATION COVERS. Form 84545-469 (Rev. 10-79) GeneJr.a.l SbUemen-t a 11 I n-ten-t ~~ Spec-tal Even-t uc.elU U U -w -the -<.n-ten-t 06 -the SpJUng6-<.e1.d Cdy Cou.nc.M'. to c.olU-<.dVt the heaLth, M.6ety, and .{.1lIpac;t an the CA.taelU 06 aWL c.ommLl.Yl.{..;ty when Jr.ev-<.e.LllU1g Jr.equuu 60Jr. -6 peCA.a1. even-t uc.elU u. FOJr. -th.w Jr.e.a.6on, the Cou.nc.M'. w.til. addJc.U-6 [but w.til. no-t be Luru.;ted to) the. 60UoWUlg c.onc.VtIU whe.n plWc.U-6-<.ng -6uc.h UC.e.IUe. Jr.eouuu. 7. Me.a.-6WLU c.on-temptaJ:e.d 60Jr. C.On-tiUl'lIIIe.n-t 06 the. e.ve.n-t to the. -6pe.u6-<.ed Mea . } (' - I r / /" , _ . / L. /)" J I~v::..e-> '"-IV j.,-.1"t;-u::~D_c- lc ",/ tG 7..Jr-" ~. /~ . rc._:~ .j' q .r""::' ~10 ~ :..,.L({..i" /::. ~,~ ''---tr/ -- -'~ J '" .~ _/. c( "c-,..-", #'- ~r t ' Z. Impac.t an the. nughboJr.hood I zoYU.ng pJr.ov-W-<'OIU, oc.c.upancy Me., paltlu,lg, pJr.ue.nce. 06 atc.ohot, etc..). ~j-.2---# _~ 5-/"i~? r~ ~ /t~ ~~ . / ' / ~ r;-,/;J.~ ~ ('--:-<-;.i./.l / /c/Li/-L.-{' ~....uJ //) /~/ ~ LC / J . /e--c{',,':7{ _<--1 S~I#-r--? "-. \ -tf?t-l:J /t'1fJ _t-.~~~,-,,"/'Z -:; t.G ?_: -tV---tJ /#?-'/;-"-'_'--vJ __ , -~"'- ,(.,,~ tr J ,- / C-,."".r ~ --? io,;!....-v' r'~ 3. AppJr.opJUaJ:e. -6e.c~y PMV-W-<'~IU., / __ . (" f. ( f,U fi, L? ~ t<;t;.U. c-/c.a_....) &f...- ~ .-/"- ~ (/1 J;. ~ J~ tf' ; /" /' ~ . C/.:;1 " ,.. r ~r . I (' ,-/ '.{.'0LA>-.L I.. '- &(.. . ....c-<:" ~-,-' r. .-;. 7 " tf--(;;{.~..--....r _.<..-. ~ -J- / '/ '~ " tt.{/ [,7 c.. (} e /rr.-<C". $t:-r,.:--k'c... /! ' /1 /J /" /' /~ ~ _<- 'r::- vi {/ L L' LV ....-f.....~~. lor' '" /" l..- I ~(. d ft r-t.- &t:L- ---- . Clty of Sprlngfleld * Flnance Depaf'tment 225 North 5th Street * Sprlngfleld, OR 97477 * 503/726-3705 '- TIllS APPLICATION MUST BE ENOORSED BY THE At-t'lVt'rtIATE PERSONS AS INDICATED BELCW t:\UUl<l:. REI'URNTIlG 'KJ THE Ul<l:."'-'" LIQUOR CONI'OOL COMMISSION. () TIllS SEcrION MUST BE COMPLEI'ED BY THE PERSON HAVTIlG ClJ::>Luui OF THE t'KUt'J:.K.Li WHERE THE EVENT IS 'KJ BE HELD OR HIS Kt.>'1<J:BENI'ATIVE. Th~s apphcatwn has been sub1u.tted to 4 &;/~) '7'9~-e4.-1 ,,-1.-~.~ '. . and Ireets mth = approval. . ~j~) /t)~/~;.,) .." (Author~zed s~qna1:ure) .? - .:kJ -.J11L1 (Date) 14. TIllS SECTION MUST BE COMPLEI'ED BY THE CHIEF OF POLICE FOR TIlLVKr\..Jl<ATE!) CITIES OR THE COUNTY SHERIFF FOR UNTIlCuKr\..Jl<ATE!) AREAS OR THEIR AUlliORIZED l<l:.P1<J:.::>.t:.l'JTATIVES. Th~s apphcatwn has been sub1u.tted to 7""A~ S;I#I/V'/';;~// a,et< ~,f A/;CL Th:LS off~ce rc~v",,=,ds X GRANT or RmJSE* * If recomrrendat~on ~s RmJSE, please illd~cate grounds for refusal 4kd72p~ ~~~nZed s"iqnature) .?-2.s--?6 (Date) , OFFICE USE ONLY SUMMARY OF EVENT: DESCRIBE ACI'IVITY, PAST OPERATION, HCW POLICED: Date rece~ved I cert~fy that the at.ove lllfonnatwn has been rev~ewed by Ire. (Narre and hUe) (Date) Certlf~cate of Authonty to operate ~ssued. (Copy enclosed) Forwarded re-.v,,"u",udJ.ng staff act~on. Supplerrental repJrt enclosed. RESTRIcrIONS: