ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL 400 W Congress #521 Tucson AZ 85701-1352 (520) 628-6595 800 W Washington 5th Floor Phoenix AZ 85007-2934 (602) 542-5141 RESTAURANT OPERATION PLAN PRINT – USE BLACK INK LICENSE # 1. List by Make, Model and Capacity of your : Grill Oven Freezer Refrigerator Sink Dish Washing Facilities Food Preparation Counter Other Other Other 2. Print the name of your restaurant: 3. Attach a copy of your menu (Breakfast, Lunch and Dinner including prices). 4. List the seating capacity for: a. Restaurant area of your premises [ ] b. Bar area of your premises [ ] c. Total area of your premises [ ] 5. What type of dinnerware and utensils are utilized within your restaurant? ¨ Reusable ¨ Disposable 6. Does your restaurant have a bar area that is distinct and separate from the restaurant seating? (If yes, what percentage of the public floor space does this area cover)? o Yes % o No 7. What percentage of your public premises is used primarily for restaurant dining? (Does not include kitchen, bar, cocktail tables or game area.) % *Disabled individuals requiring special accommodations, please call the Department. Lic0114 05/2004 American LegalNet, Inc. www.FormsWorkflow.com 8. Does your restaurant contain any games or televisions? ¨ Yes ¨ No If yes, specify what types and how many of each type (Televisions, Pool tables, Video Games, Darts, etc). 9. Do you have live entertainment or dancing? (If yes, what type and how often?) o Yes o No 10. Use space below or attach a list of employee positions and their duties to fully staff your business. Attach additional sheets if necessary I, ________________________________________________, hereby declare that I am the APPLICANT filing this (Print full name) application. I have read this application and the contents and all statements true, correct and complete. State of County of_____________________ The foregoing instrument was acknowledged before me this X (Signature of APPLICANT) day of Day Month Year My commission expires on: (Signature of NOTARY PUBLIC) 2 American LegalNet, Inc. www.FormsWorkflow.com