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Dancing, Cabaret, and Entertainment Application

Permits & ApplicationsLicense application - PDF, 1 page

Application - text version

DANCING- CABARET- ENTERTAINMENT LICENSE APPLICATION

FILL OUT THIS BLOCK

Premises:

Section: Block: Lot(s):

DO NOT WRITE IN THIS BLOCK

Application No.: Filed: 20

Required Fee $:

Filing Fee $:

Balance Paid $:

License No.: Issued: 20

USE TYPEWRITER OR PRINT CLEARLY ANSWER ALL QUESTIONS

TO BE FILLED IN CONNECTION WITH A PUBLIC ASSEMBLY LICENSE APPLICATION

OR AS AN ACCESSORY TO AN EXISTING PUBLIC ASSEMBLY LICENSE

(1) Address of Premises to be Licensed:

(2) Name of Premises Established: Tel. No.:

(3) Owner of Premises to be Licensed: Tel No.:
Address:

(4) Owner of Business to be Licensed: Tel No.:
Address:

(5) Does a current Public Assembly License for this premises exist? ○ Yes ○ No If yes, public assembly license #: currently in effect for this premises. If no, this application must be filed with public assembly license application.

(6) Describe the type of entertainment to be included under this license (i.e. dancing - live bands - cabaret shows, etc.)

FOR OFFICE USE ONLY

  1. Classification of building (type of construction)
  2. Maximum number of persons permitted: Patrons Employees Total:
  3. Have fingerprints been submitted where required?
  4. Has Agency Designation form been submitted where required?
  5. List other documents submitted:

SUPERINTENDANTS RECOMMENDATIONS

Based on the Statements in the Application, Inspection Reports, Office Reports and other relevant matter, it is recommended that a License be: ○ Approved ○ Denied

Date: , 20

Inspected By:

Applicant Notified: , 20


Superintendent of Building