Michigan Department of Licensing and Regulatory AffairsLiquor Control Commission (MLCC) Toll-Free: 866-813-0011 - www.michigan.gov/lcc Business ID: Request ID:(For MLCC Use Only)Temporary Authorization Application(Authorized by R 436.1023(2),(3), R 436.1403(2), R 436.1407, and R 436.1419) Licensee name(s):Address:City:Zip Code:Contact name:Email:Phone: Part 1 - Licensee Information Individuals, please state your legal name. Corporations or Limited Liability Companies, please state your name as it is filed with the State of Michigan Corporation Division. Part 2 - Temporary Authorizations Available A licensee may request up to twelve (12) daily authorizations for each type of temporary authorization in a calendar year. A Temporary Outdoor Service Permit - Complete Parts 3, 8, and 9 Temporary Dance Permit - Complete Parts 4 and 9 Temporary Entertainment Permit - Complete Parts 5 and 9 Temporary Extended Hours Permit - Complete Parts 6 and 9 Temporary Specific Purpose Permit - Complete Parts 7, 8, and 9Date(s) of event: Date(s) of event:Describe event: Describe event:Date(s) of event:Describe event: ***This application, all required documents, and a $70.00 inspection fee must be submitted at least ten (10) days in advance of your event for your request to be considered by the Commission.***1. Check below if the event(s) listed above will include any of the following: Dancing Contests Tournaments Classic Cars Motorcycles Festivals Concerts 2. List the exact dimensions of the proposed area: *Submit a diagram of the outdoor area with application*7. Describe type of security that will be used for event(s) and how it will be utilized to secure and monitor to prevent sales to minors and visibly intoxicated persons:feet Xfeet =square feetfeet Width Length 3. Describe type and height of the barrier that will be used to enclose the area: 4. Will the proposed outdoor service area be connected to the licensed premises? 5. Is the entrance/exit point(s) for the proposed area through the licensed premises?6. Are there any dedicated streets or intervening property between proposed area and the licensed premises? No Yes If No, what is the distance from the licensed premises to the proposed area? No Yes NoLCC-206 (02-19) $70.00 Inspection Fee - Make Check Payable to State of Michigan MLCC Use - Fee Code 4037 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. Part 3 Continued - Temporary Outdoor Service Permit Information Yes No8. Is the location of the proposed area owned, rented, or leased by the licensee? If No, submit a lease or written permission which grants the licensee the use of the proposed area. *Submit written permission from a city, township, or village if the proposed area is located on municipally-owned property* Yes No9. Is the proposed area located in the same local governmental unit as the licensed premises?If No, please explain: If No, the licensee will be restricted to providing only table service in the proposed area unless a new Additional Bar Permit has been requested by the licensee and approved by the Commission. This requirement applies only to Class C or B-Hotel licenses. Yes No10. Does the licensee currently hold an Additional Bar Permit that will be utilized in the proposed area? Part 4 - Temporary Dance Permit Information1. List the dates requested for a Temporary Dance Permit: 267 Licensees that currently hold a Dance Permit at the licensed premises do not need to request a Temporary Dance Permit for dancing in a Temporary Outdoor Service area. 267 The dance floor must be at least 100 square fee, be clearly marked, and shall not have tables, chairs, or other obstacles on the dance floor while customers are dancing. Part 5 - Temporary Entertainment Permit Information1. List the dates requested for a Temporary Entertainment Permit:2. Describe the type of entertainment provided: 267 Licensees that currently hold a Entertainment Permit at the licensed premises do not need to request a Temporary Entertainment Permit for entertainment in a Temporary Outdoor Service area. 267 A Temporary Entertainment Permit does not allow for topless activity on the licensed premises. 3. Will the entertainment provided under the Temporary Entertainment Permit include a contest with prizes totalling over $250.00 in retail value?If Yes, the licensee must complete Form LCC-207 and submit with this application. No alcoholic beverages may be used as part of any contest or as a prize for a contest. No licensee may provide anything of value from another licensee without prior Commission approval. No Yes Part 6 - Temporary Extended Hours Permit Information2. List the dates and hours requested for a Temporary Extended Hours Permit: 267 Licensees that currently hold an Extended Hours Permit in conjunction with a Dance or Entertainment Permit at the licensed premises do not need to request a Temporary Extended Hours Permit for use with a Temporary Outdoor Service area. 1. Select the permit type that requires a Temporary Extended Hours Permit*: Dance Permit Entertainment Permit Part 7 - Temporary Specific Purpose Permit Informaton2. List the dates and hours requested for a Temporary Specific Purpose Permit: 267 Licensees that currently hold a Specific Purpose Permit for an approved purpose at the licensed premises do not need to request a Temporary Specific Purpose Permit for the same purpose for use with a Temporary Outdoor Service Permit. 267 A Temporary Specific Purpose Permit requires a recommendation from the local law enforcement agency that has primary jurisdiction over the licensed premises. The local law enforcement agency must complete Part 8 of this application. 1. Indicate the activity that requires extended hours* (e.g. food service):*Hours of Operation Weekdays and Saturdays - Beer, wine, and spirits may be sold from 7:00 a.m. to 2:00 a.m. of the next day, provided that the sale of spirits is legal in the governmental unit where the license is desired. Sundays - Legal hours of sale on Sundays are from 7:00 a.m. until 2:00 a.m. of the next day, provided the sale of alcoholic beverages on Sunday is legal in the governmental unit and the appropriate permit has been approved by the Commission and the permit has been issued.LCC-206 (02-19) American LegalNet, Inc. www.FormsWorkFlow.com Part 8 - Local Law Enforcement Recommendation for Temporary Outdoor Service Permit and Temporary Specific Purpose Permit The local law enforcement agency with primary jurisdiction over the event location must complete this section.Name of law enforcement agency:Address of law enforcement agency: Print Name & Title of Reviewing Officer:Phone number of officer:Email of officer:I certify that I have reviewed this application and recommend the approval of the Temporary Outdoor Service Permit or Temporary Specific Purpose Permit by the Michigan Liquor Control Commission. Signature of Reviewing Officer Date Please return this completed form along with corresponding documents and fees to: Michigan Liquor Control Commission Mailing address: P.O. Box 30005, Lansing, MI 48909 Hand deliveries or overnight packages: Constitution Hall - 525 W. Allegan, Lansing, MI 48933 Fax to: 517-284-8557Part 9 - Signature of Licensee If approved, the license shall not sell, or allow the consumption of alcoholic beverage outdoors, except in the defined area, under administrative rule R 436.1419. If approved, the licensee shall provide service of alcoholic beverages in the outdoor area only by wait staff servicing the tables, unless the licensee uses an approved additional bar in the area where customers may obtain their alcoholic beverages from a bartender using a currently authorized additional bar or receiving approval by the Commission for a new Additional Bar Permit. This requirement applies only to Class C or B-Hotel licenses. Refrigeration trucks and/or trailers cannot include an alcoholic beverage logo and must be rented by the licensee from a non-wholesale company. If the refrigeration truck/trailer allows customer acces