Application For Reconstruction To Liquor License {113}

APPLICATION FOR RECONSTRUCTION TO LIQUOR LICENSE NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.nebraska.gov Office Use Application: Must include processing fee of $45.00 checks made payable to Nebraska Liquor Control Commission (NLCC) or you may pay online at www.ne.gov/go/NLCCpayport Must include simple hand drawn sketch showing area to licensed, must include outside dimensions in feet (not square feet), show direction north. NO BLUE PRINTS May include approval from the local governing body; no reconstruction shall be approved unless endorsed by the local governing body Check with your local governing body for any additional requirements that may be necessary in making this request for reconstruction LIQUOR LICENSE #__________________________________CLASS TYPE________________________ LICENSEE NAME________________________________________________________________________ TRADE NAME___________________________________________________________________________ PREMISE ADDRESS______________________________________________________________________ CITY_________________________ZIP CODE_______________COUNTY_________________________ CONTACT PERSON______________________________________________________________________ PHONE NUMBER OF CONTACT PERSON__________________________________________________ EMAIL ADDRESS OF CONTACT PERSON__________________________________________________ BARCODE LABEL FORM 113 REV APR 2015 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 1. What is being reconstructed? Explain why this area is being rebuilt _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 2. Include a sketch of the area to be licensed showing: Include sketch of building to be licensed with length & width in feet Is outdoor area to be licensed include on sketch with length & width Indicate the direction north Indicate single story building or give number of floors, how many are licensed Indicate if there is a basement to be included in the licensed description If reconstructing an outdoor area explain: type of fencing height of fence length & width of outdoor area in feet 3. 12.07 Outdoor area shall mean an outdoor area included in licensed premises, which is used for the service and consumption of alcoholic liquors and which is contained by a permanent fence, wall or other barrier approved by the Commission and shall be in compliance with all building and fire, or other applicable local ordinances. Rule Chapter 2­012.07 I acknowledge under oath that the premises as reconstructed to comply in all respects with the requirements of the act. Neb Rev Stat §53-129 ________________________________________________ Signature of Licensee or Officer State of Nebraska County of _____________________________________ The foregoing instrument was acknowledged before me this __________________________________________ by __________________________________________________ Date name of person acknowledged (individual(s) signing document) Affix Seal __________________________________________ Notary Public signature FORM 113 REV APR 2015 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com