Utah > Statewide > Department Of Alcoholic Beverage Control
Restaurant On Premise Retail License Application (Limited Service) - Utah
| Restaurant On Premise Retail License Application (Limited Service) Form. This is a Utah form and can be used in Department Of Alcoholic Beverage Control Statewide . |
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Utah Department of Alcoholic Beverage Control 1625 South 900 West P.O. Box 30408 Salt Lake City, UT 84130 RESTAURANT ON-PREMISE RETAIL APPLICATION CHECKLIST Website: www.abc.utah.gov Phone 801-977-6800 Fax 801-977-6889 Restaurant (Limited Service) The items below must be completed and submitted no later than the 10th of the month. Incomplete applications may be returned for additional information in order to process the application. Applicants with completed applications will be notified of the next monthly Utah Alcoholic Beverage Control Commission meeting when the application will be considered. All licenses issued under a statewide population quota require a brief presentation to the Commission. 1. ____ 2. ____ Completed Application Form $825 Initial licensing fee $330 non-refundable application fee 3. ____ Ownership entity / organizational documents filed with Utah Department of Commerce Individual / Sole Proprietor Partnership written partnership agreement Corporation articles of incorporation Limited Liability Company articles of organization 4. ____ Criminal history background documents Fingerprint card [FBI Form FD 258 or similar] Informed Consent and Release of Liability Third-party Attestation/Stipulation Third-party background check Fees Local consent to the issuance of the license from city, town or county where the restaurant is located Current local business license $5,000 Cash or corporate surety bond (template attached) Licensed entity listed as the Principal Restaurant name listed as `doing business as' Certificate of insurance for public liability and dramshop (liquor liability) coverage (template attached) (minimum dramshop coverage of $1,000,000 per occurrence/$2,000,000 in the aggregate). Projected profit and loss statement [Pro forma income statement] (template attached) Food Menu Alcoholic product List or menu identifying individual brand or price level Business / Property Information 12. ____ 13. ____ 14. ____ 15. ____ 16. ____ Lease agreement Floor plan of retail license premise including areas of consumption, storage, sale or furnishing an alcoholic product Business tax, withholding, workforce services identification documentation Utah Sales Tax & Payroll withholding Utah Workforce Services TC-721 Utah State Tax Commission Exemption Certificate Evidence of proximity to schools, churches, libraries, playgrounds and/or parks 5. ____ 6. ____ 7. ____ 8. ____ 9. ____ 10.____ 11.____ Federal Taxpayer Identification Copies of Utah laws and commission rules pertaining to restaurants, and a list of factors considered in the evaluation of license applications are available at www.abc.utah.gov. If you have any questions concerning these forms or the application process, please contact our DABC Licensing and Compliance Division at (801) 977-6800. DABC (RE) Checklist (07/2012) Authority: UCA 32B American LegalNet, Inc. www.FormsWorkFlow.com Utah Department of Alcoholic Beverage Control 1625 South 900 West P.O. Box 30408 Salt Lake City, UT 84130 Restaurant (full) Initial license fee $2,200 Application fee (non-refundable) $330 RESTAURANT ON-PREMISE RETAIL LICENSE APPLICATION Restaurant (limited) Initial license fee $825 Application fee (non-refundable) $330 Licensing and Compliance Division Application Number ___________ Restaurant (Beer Only) Initial license fee $825 Application fee (non-refundable) $330 Ownership Information 1. Ownership Entity: __________________________________________________________________________________ Entity Type: Individual Partnership Corporation Limited Liability Company 2. DBA:(assumed name of business) _________________________________________________________________________ 3. Business address: _________________________________________________________________________________________________ STREET CITY STATE ZIP 4. Mailing address: _________________________________________________________________________________________________ (IF DIFFERENT) STREET CITY STATE ZIP 5. Business Phone: ________________________ Fax:_______________________ Other/office: _____________________ 6. Contact person: ___________________________ Phone number: ________________ Email _____________________ 7. Manager: ________________________________ Phone number: ________________ Email: _____________________ 8. Other alcoholic beverage licenses currently or previously held by applicant/entity/principals: _________________________________________________________________________________________________ Business / Property Information 9. Date opened for business (projected): ______________ Days / hours of operation: ______________________________ 10a.Monthly gross food sales (projected): _____________ 10b. Monthly gross alcohol sales (projected):________________ 11. Projected annual cost of alcohol (liquor, wine, heavy beer) _____________________ (applicable to full service restaurant) 12. Square footage: _________________ Seating/dining capacity: _________________ # of Parking stalls: ____________ 13. Business tax, withholding, workforce services identification numbers Utah Sales Tax __________________________ Utah Payroll Withholding ________________________ Federal Taxpayer Identification ____________________ Utah Workforce Services ___________________ 14. Owner of real property & building (lease holder) Name: _____________________________________ Phone: _____________________________________ Address: ________________________________________ City,State,zip ______________________________________ 15. Proximity: List any private or public schools, churches, public libraries, public playgrounds, parks, or educational facilities (nursery school, infant day care center or trade / technical school) located within 600 feet pedestrian travel or 200 feet straight line. ______________________________________________________________________________________________ ______________________________________________________________________________________________ DABC R101 (07/2012) Authority: UCA 32B American LegalNet, Inc. www.FormsWorkFlow.com 16. Ownership / Management List individuals; managers; partners; corporate officers; any stockholder owning 20% of the corporation; employees appointed to manage or direct operations A criminal history background check must be submitted on each person listed. See Instructions for list of documents required. US Citizen if "no", provide residency status in section 17. Use additional sheets if necessary. Date of US Position Percent
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