State of Alaska Alcoholic Beverage Control Board 5848 E Tudor Rd Anchorage, Alaska 99507 Phone: 269-0350 RESTAURANT CATERER’S PERMIT Permit No. __________________ Application Fee: $50.00 Fee Paid __________________ http://www.dps.state.ak.us/abc NOTICE TO APPLICANT: After approval by the appropriate law enforcement authority, send the completed form along with the $50.00 fee to the Alcoholic Beverage Control Board. When the permit has been approved, it will be returned for posting at the event. Name of Licensee(s) Restaurant or Eating Place License No. Contact Person & Phone No. Doing Business As Location of Premises Licensee’s FAX Number Mailing Address (Street or P.O. Box, City, State and Zip Code) The restaurant or eating place licensee named above hereby makes application under Alcoholic Beverage Control Board regulation 15 AAC 104.680 for permission to cater the event and temporary premises described below. Event Event To Be Held at: Purpose Date of Event (Name and location of premise to be licensed) Time of Event I/We certify this written notice is submitted as required under 15 AAC 104.680 AND WILL BE RETURNED TO THE BOARD WITHIN 48 HOURS AFTER THE EVENT HAS ENDED. Any person observed to be giving or selling alcoholic beverages to a person under the age of 21 or a drunken person may be cited under AS 04 .16.030, AS 04.16.040, AS 04.16.050, AS 04.16.051, AS 04.16.052 or AS 04.16.060. SIGNATURE OF LICENSEE(S): ____________________________________________________________________________________________ Approved Disapproved By: __________________________________Date______________________ Law enforcement agency with jurisdiction over site Reason Disapproved: _________________________________________________________________________________________ ___________________________________________________________________________________________________________ This permit is only for the event on the date and at the location requested. This permit authorizes the licensee to sell or dispense beer or wine before and during service of food provided by the licensee at a designated location for a banquet or dinner event held off the licensee’s licensed premises. The licensee(s) is hereby notified that any violation of any Alcoholic Beverage Control Board law or regulation will be charged against the licensee(s). This permit will be issued unless a protest is noted by the appropriate police authority, or if the Board finds that it would not be in the best interest of the public. Restaurant Designation Approved for the licensees designation permit No. __________________ by: ___________________________Date_________________ Alcoholic Beverage Control Board Reason Disapproved: ________________________________________________________________________ Approved Disapproved Menu /Food Service Instructions: Draw a detailed plan of the premises where the event will be held in the space below; show all entrances and exits, and all fixtures such as counters, bars, coolers, stages, etc. Include the dimensions of the Premises. Outline in red the areas where alcoholic beverages will be sold, served and consumed.