HomeMy WebLinkAboutItem 09 Addis Ethiopian Cuisine Liquor License AGENDA ITEM SUMMARY Meeting Date: 6/3/2019
Meeting Type: Regular Meeting
Staff Contact/Dept.: Robin Holman - DPW Staff Phone No: 541-726-3662
Estimated Time: Consent Calendar
S P R I N G F I E L D C I T Y C O U N C I L Council Goals: Mandate
ITEM TITLE: LIQUOR LICENSE APPLICATION FOR A NEW OUTLET FOR ADDIS
ETHIOPIAN CUISINE LLC, DBA: ADDIS ETHIOPIAN CUISINE.
ACTION REQUESTED: Endorsement of OLCC Liquor License Application for Addis Ethiopian Cuisine, located at 321 Main Street Springfield, OR 97477.
ISSUE STATEMENT: The owner of Addis Ethiopian Cuisine LLC has requested the City Council to endorse its OLCC Liquor License Application.
ATTACHMENTS: Attachment 1. OLCC Liquor License Application.
DISCUSSION/ FINANCIAL
IMPACT:
The license endorsement for Addis Ethiopian Cuisine LLC DBA: Addis Ethiopian Cuisine is for a New Outlet with Limited On-Premises Sales. The license
application has been reviewed and approved by the appropriate City Departments.
ffi OREGON LIQUOR CONTROL COMMISSION
LIQUOR LICENSE APPLICATION
1. Application. Do not include any OLCC fees with your application packet (the license fee will be collected at a later
time). Application is being made for:
2. ldentify the applicant(s) applying for the license(s). ENTITY (example: corporation or LLC) or INDIVIDUAL(S) applying
for the license(s):
(Applicant #1)(Applicant S2)
License Applied For:CITY AND COUNW USE ONIY
Date application received:
Name of City or County:
Recommends this license be:
E Granted E Denied
By
Date
tr Brewery 1't Location
tr Brewery 2nd Location
tl Brewery 3'd Location
tr Brewery-Public House Lst location
tr Brewery-Public House 2nd location
tr Brewery-Public House 3'd location
tr Distillery
tr Full On-Premises, Commercial
tr Full On-Premises, Caterer
tr Full On-Premises, Passenger Carrier
tr FullOn-Premises, Other Public Location
tl FullOn-Premises, For Profit Private Club
tr Full On-Premises, Nonprofit Private Club
tr Grower Sales Privilege 1't location
tr Grower Sales Privilege 2nd location
! Grower Sales Privilege 3'd location OLCC USE ONLY
Date application received
d8ntBy -A flll-au-
I
Date application acc lly complete:
By:
License Action(s):Nlo
& Limited On-Premises
n Off-Premises'D Off-Premises with Fuel Pumps
tr Warehouse
tr Wholesale Malt Beverage & Wine
tr Winery 1't Location
tr Winery 2nd Location
tr Winery 3'd Location
(Applicant #3)(Applicant S4)
OLCC Liquor License Applicarion (Rev 10/2013)
OLCC USE ONLY OLCC FINANCIAL SERVICES USE ONLY
Attachment 1, Page 1 of 4
OREGON LIQUOR CONTROL COMMISSION
LIQUOR LICENSE APPL ICATION
3. Applicant #L
A&;+ Egr;*t^ C*i=.^ c lJ-L
Applicant #2
Applicant #3 Applicant #4
4. Trade Name of the Business (Name Customers Will See)
5. Business Address (Number and reet Address of the Location that will have the liquor license)
3at
City
3p.,,r10,e-ld
County
La-,'r,
Zip Code
at+71
6. Does the bu:-iness address currently have an OLCC liquor license? il VfS Xruo
7. Does the business address currently have an OLCC marijuana ricense? Eyrs EIruo
8. Mailing Address/PO Box, Number, Street, Rural Route (where the OLCC will send your mail)
25ota co Lta.qe C---rt-
City J
e-nata-
State
DR
Zip Code
17+81
9. Phone Number of the Business Location(Eqr) 5tD - 50tl Email Contact for this Application
Contact Person for this Application Phone Number
5e+l aat -?ta
Mailing Address
25o7a @oqe U-,
City
Ver.otr-
State
OR
Zip Code
1?Lls 7
I understand that marijuana (s as use, consumption, ingestion, inhalation, samples, give-away, sale, etc.) is
prohibited on the licensed premises.
I attest that all answers on all forms, documents, and information provided to the OLCC are true and complete.
Apolicant Sienature(s)
o Each individual person listed as an applicant must sign the application.r lf an applicant is an entity, such as a corporation or LLC, at least one person who is authorized to sign for the entity
must sign the application.o A person with the authority to sign on behalf of the applicant (such as the applicant's attorney or a person with
power of attorney) may sign the application. lf a person other than an applicant signs the application, please
provide s
(Applicant#1.)(Applicant s2)
(Applicant#3)
authority
(Applicant #4)
OLCC Liquor License Apptication (Rev. 10/2018)
ffi
Attachment 1, Page 2 of 4
OREGON LIQUOR CONTROL COMIMISSION
LITUITED LIABILITY COIUPANY QUESTIONNAIRE
Please Pint or Type
LLC Name, Addis Lll. Year Fited:o 5
Trade Name (dba)
Business Location Address
C 5
rn
t
1
List Members of LLC:Percentage of Membership lnterest:
lDo-7P'{Ae.kLLt.F;vrz-
(managing member)
(members)
(Note: lf any LLC member is another legal entity, that entity must also complete an LLC, Limited
Partnership or Corporation Questionnaire. lf the LLC has officers, please tist them on a separate
sheef of paper with their titles.)
Server Education Desig nee: Mzatil Fi Lru DOB:
I understand that if my answers are not true and complete, the OLCC may deny my license application.
Sisnature: nlf LL tf fi,bzE e\r)r€C rllrq
2.
3.
4.
5.
6.
(title)
1-800-452-OLCC (6s221
(name)
www.olcc.state.or.us
Date a/
(rev. 8/1 1)
Ztp code: 9 7Ll7?
Attachment 1, Page 3 of 4
OREGON LIQUOR CONTROL COIVN/ISSION
BUSI N ESS I N FORIVIATION
Please Print or Type
Applicant Name hone
Trade Name (dba)
Business Location Address
City:5or',, ,rliu\LJ
DAYS AND HOURS OF OPERATION
Business Hours
Sunday
I\rlonday
Tuesday
Wednesday
Thursday
Friday
Saturday
Itl30 to :oo Sunday
[/onday
Tuesday
Wednesday
Thursday
Friday
_to
-to-to
-to
to-
Outdoor Area Hours The outdoor area is used for:
tr Food service Hours
tr Alcohol service Hours
O Enclosed, how
The exte
to
is adequately viewed and/or
by Service Permittees
(lnvestigator's lnitials)
It:3O to ,3r.:oO
It r3o b al 'aoIt7,?O to J (:eD
to-to-
It rac - Z'.bO D:OO - q'.OO
Seasonal Variations: EI Yes E[ No lf yes, explain
tr
H
tr
tr
tr
Live Jt/usic
Recorded ltllusic
Nude Entertainers
Check all that apply:
fl xaraoke
EI coin-operated Games
EI vio"o Lottery Jr/achines
n sociat Gaming
E PootTables
E ot"r'
Outdoor:
Other (explain)
Total Seating: 3A
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
to
to
DJ Music
ngDanci to
to
to
- Restaurant:
Lounge:
Banquet:
OLCC USE ONLY
lnvestigator Verified Seating:_(Y) _(N)
lnvestigator lnitials:_
t'taf o.
I understand if my answers are not true and m lete,the OLCC may deny my license application.
rq
1-800-452-OLCC (65221
ENTERTAINMENT DAYS & HOURS OF LIVE OR DJ MUSIC
SEATING COUNT
Applicant Signature:
www.oregon.gov/olcc
Date J Irel
(rev. 12/07)
t
ZrP Code: 1-7 +1 -7
Attachment 1, Page 4 of 4