Print Form Michigan Department of Licensing and Regulatory Affairs MICHIGAN LIQUOR CONTROL COMMISSION (MLCC) 7150 Harris Drive, P.O. Box 30005 Lansing, Michigan 48909-7505 FOR MLCC USE ONLY Request ID # APPLICATION FOR OFFICIAL PERMIT FOR DIFFERENCE IN HOURS OF OPERATION Business ID # [Authorized by MCL 436.1916 and R 436.1403] _________________________________________________________________________________________________ Applicant or Licensee Name: Address: Type of License: License No.: The MLCC is requested to grant an extended hours permit for: (check boxes that apply). INSPECTION FEE AND MAKE PAYABLE TO THE STATE OF MICHIGAN. INCLUDE A $70.00 Dance (To apply for this purpose you must have a separate Dance Permit issued by the MLCC) Entertainment (To apply for this purpose you may have to have a separate Entertainment Permit issued by the MLCC). Operating our restaurant for the sale of food (Must have a full Service kitchen) Operating night league bowling, tournaments or Sunday morning bowling Registering golfers Registering Skiers Registering Tennis Players Registration of Guests Meetings Special Events, Indicate below Specific Event or Events that will be occurring. Athletic Activities, Indicate below Specific Athletic activities that will be occurring. Others Please Specify Activities: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Application for Difference in Hours of Operation (cont'd) NOTE: The licensed premises may not be occupied by anyone except the licensee and bona fide employees who are working between the hours of 2:30 A.M. and 12:00 Noon on any Sunday or from 2:30 A.M. until 7:00 A.M. on any other day. Please indicate below the extended hours you are applying for to conduct the activities indicated on Page 1. Weekdays ______ A.M. to ________ A.M. Note: Saturday night after midnight is Sunday and requires Sunday hours if the premises is to be occupied after 2:30 A.M. Sundays _______ A.M. to ________ A.M. /P.M. Will Licensee be conducting the requested activity? YES NO If no, attach a request for waiver of R 436.1437 and copy of concession and/or licensing agreement for person conducting that activity. It is understood that the licensee issued an extended hours permit shall not allow customers on the licensed premises during the time period provided by the extended hours permit unless the activities, and only those activities, allowed by the extended hours permit are occurring. If you apply for two separate activities and the activities are for different hours you must fill out and attach a separate application. THIS PERMIT DOES NOT ALLOW THE SALE, SERVICE, OR CONSUMPTION OF ALCOHOLIC LIQUOR DURING THE EXTENDED HOURS. ISSUANCE OF THIS PERMIT REQUIRES APPROVAL BY YOUR LOCAL LAW ENFORCEMENT AGENCY. IF MAKING APPLICATION FOR EXTENDED HOURS FOR DANCE OR ENTERTAINMENT A RECOMMENDATION FROM THE LOCAL LEGISLATIVE BODY IS ALSO REQUIRED. Your request will be referred to your local law enforcement agency and local legislative body (if needed) for their recommendation upon receipt of a complete and acceptable application and the required $70.00 inspection fee. THE LICENSEE/APPLICANT, AN AUTHORIZED CORPORATE OFFICER OR MEMBER OF A LIMITED LIABILITY COMPANY MUST SIGN THIS APPLICATION. Licensee or Applicant Signatures: ___________________________ _____________________________ ___________________________ _____________________________ CONTACT INFORMATION Name: Address: (street address) (city) (state) Phone Number: E-Mail Address: Page 2 of 2 Print Form LC-1112 (Rev. 04/11) Authority: MCL 436.1916 and R 436.1403 Completion: Mandatory Penalty: No License and/or Permit The Department of Licensing and Regulatory Affairs will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability, or political beliefs. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency. American LegalNet, Inc. www.FormsWorkFlow.com