Report Summary for December 2009 Commission Meeting

Fat Jack’s, LLC
Sherri Doss, Managing Member
Tracy Doss, Member
FAT JACK’S SALOON / MYNT GENTLEMEN’S CLUB
3390 NE Sandy Blvd
Portland, Or 97232


Full On-Premises Sales
New Outlet


Issue

The City of Portland gave the applicant an unfavorable recommendation based on what
it believes is the applicant’s problems at another licensed location.

The Laurelhurst Neighborhood Association also gave an unfavorable recommendation,
also based on the reason cited by the City of Portland.

Other neighbors are opposed to the application based on problems that occurred under
the prior owner.


Discussion

1. Applicant’s problems at another licensed premises: OAR 845-005-0326(1)

The City of Portland and the Laurelhurst Neighborhood Association mistakenly believe
that applicant Tracy Doss was previously licensed at another premises called Fusion.
Mr. Doss was a manager of Fusion; however, he was not a licensee of the Commission
at that premises so this reason does not provide a basis to deny this license.

2. History of problems at the premises: ORS 471.313(5)

Regarding the incidents involving noise complaints, since there were no citations issued
by the City of Portland for violating its noise ordinance, the incidents involving noise
complaints can’t be considered under ORS 471.313(5).

Regarding the incidents other than those involving noise, the last incident occurred in
January 2008. The passage of time since this incident is approximately two years; this
by itself is sufficient to show that the history of serious and persistent problems is no
longer current at this premises. In addition, the applicant submitted an operating
Fat Jack’s, LLC
Report Summary for December 2009 Commission Meeting
Page 2 of 2


proposal that, if followed, should go towards preventing the problems that the prior
licensee was unable to prevent.


Executive Director Statement

I advise that the application is consistent with the criteria to grant the license.

___________________________________
Stephen A. Pharo
Executive Director
OREGON LIQUOR CONTROL COMMISSION
Liquor License Investigation

Subject: Full On-Premises Sales/Commercial Date: November 7, 2009
New Outlet


Fat Jack’s, LLC
Sherri Doss, Managing Member
Tracy Doss, Member
Fat Jack’s Saloon/Mynt Gentlemen’s Club
3390 NE Sandy Blvd
Portland, OR 97232


Regulatory Issue

The City of Portland and the Laurelhurst Neighborhood Association gave
unfavorable recommendations for this application. This report also examines
whether or not there is a history of serious and persistent problems at the
premises.

Applicant

Fat Jack’s LLC is an Oregon limited liability company formed April 2009. The
limited liability company lists Tracy Doss and Sherri Doss (husband and wife) as
its members. They each own 50% membership interest in the LLC.

Information Regarding Tracy Doss

The license application lists both Tracy Doss and Sherri Doss as premises
managers.

Tracy Doss was employed as a manager for Doss Consulting, Inc, dba Fusion
Lounge; which later changed its trade name to Spyce Gentleman’s Club. Doss
Consulting, Inc is wholly owned by Walter Doss, and currently holds a Full On-
Premises Sales license at Spyce Gentleman’s Club. Walter Doss is Tracy Doss’
father. Tracy Doss was not a licensee at Fusion Lounge/Spice Gentleman’s
Club.

The City of Portland recommendation (see below) incorrectly identifies Tracy
Doss as a licensee at Fusion Lounge/Spyce Gentleman’s Club.




Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 2 of 9

Premises

The premises is a 7,900 square feet commercial establishment with dining
seating for approximately 100 plus bar seating for 17.
The premises has three stages along with a DJ booth. The proposed menu
consists of soups, salads, burgers, sandwiches and four steak dinner entrees.
The premises also has a 10,000 square feet parking lot located immediately on
the east side of the premises

Entertainment

When this application was originally submitted, the applicant’s proposed
entertainment format was Country & Western music and dancing. The applicant
recently changed the proposed entertainment format to nude dancing.

Minor posting

The premises is posted with a #1 Minor Posting, prohibiting minors from the
entire premises during all hours of operation.

OLCC Licensing History at the Above Premises

The premises was previously licensed to Bobayo-Guerra, Inc., d.b.a. La Fortuna
Mexican Bar & Grill (La Fortuna) from November 2004 through July 2008.
During the time the premises was licensed as La Fortuna, there were numerous
residential complaints about patron noise, disorderly activity, and noise from
amplified music at the premises (for details, see criterion below.)

Bobayo-Guerra, Inc. had one OLCC violation in April 2007 for permitting a minor
in an area prohibited to minors, OAR 845-006-0335(3)(b). On 5-30-08, OLCC
Compliance Staff issued a Notice of Warning Ticket (NWT) to Bobayo-Guerra for
having a History of Serious and Persistent Problems, ORS 471.315(c).

Information from Neighbors

The Commission received 25 letters from neighboring residents objecting to this
application. The basis of their objections relate to incidents that occurred when
the premises was previously licensed to Bobayo-Guerra, Inc. and includes late
night patron noise, neighborhood litter, late night operation (past 2:00 a.m.),
disturbing amplified music from the premises, parking, and a disorderly incident
that resulted in an early morning homicide in the premises parking lot.

The Commission also received a petition with 67 signatures from area residents
opposing this application. The petition did not cite a basis for the opposition.
Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 3 of 9

Information from Eighth Church of Christ, Scientist

The Eighth Church of Christ, Scientist submitted a letter objecting to this
application. The church is located at 3505 NE Multnomah and within 500 feet of
the Fat Jack’s Saloon/Mynt Gentlemen’s Club. The basis of the Church’s
opposition is prior disorderly conduct that resulted in a homicide at La Fortuna,
parking late night noise, litter and prostitution.

City of Portland Recommendation

The City of Portland gave an unfavorable recommendation for this application
based on OAR 845-005-0326(1)(a), which gives the Commission the authority to
deny a license that is not demanded by the public interest and convenience
based on a finding that the applicant has had repeated problems at another
location during the two years preceding this application or has had a license
cancelled or renewal refused because of problems with disturbances, unlawful
activities or noise.

The City’s unfavorable recommendation letter dated September 2, 2009, states
“Tracy Doss is one of the licensees in this application” and “Mr. Doss was a prior
licensee (emphasis added) at Fusion, a night club previously located in the Old
Town Neighborhood of Portland.” According the letter, “while Mr. Doss was the
licensee at Fusion the business committed a City of Portland Time, Place and
Manner violation due to the high incidence of assaults and other nuisance related
activities. Mr. Doss was eventually able to reduce the problems by changing the
name to Spyce Gentleman’s Club, and changing the format from a night club to
an adult entertainment establishment.”

The City of Portland cites six incidents that occurred between June 1, 2008 and
July 26, 2008 at the Fusion location as evidence of problems that happened
while Tracy Doss was allegedly the licensee. The city states that since Fat
Jack’s Saloon/Mynt Gentlemen’s Club’s proposes a night club format, it believes
the high incidence of assaults and other nuisance activities that occurred while
Mr. Doss was allegedly licensed at Fusion will occur at this premises.

The City of Portland requests that the OLCC consider imposing a license
restriction should it grant the license. The recommended restriction is:

1. The licensee is required to follow the business operating plan it
submitted to the OLCC.

As noted above, Tracy Doss was not a licensee at the Fusion Lounge/Spyce
Gentleman’s Club. There is no basis to deny or restrict the license based the
City’s concerns about problems at Fusion Lounge/Spyce Gentleman’s Club.
Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 4 of 9


Laurelhurst Neighborhood Association Recommendation

Fat Jack’s Saloon/Mynt Gentlemen’s Club is located within the boundary of the
Laurelhurst Neighborhood Association (LNA). In its letter to the Commission
(un-dated), the LNA wrote “At its general meeting on September 29, 2009, the
Laurelhurst Neighborhood Association voted to support the Portland Police
Bureau’s September 2, 2009 unfavorable recommendation.” The LNA gave the
same reasons the City of Portland gave as the basis for its unfavorable
recommendation.

After receiving notice from the applicant about the proposed change in their
entertainment format, OLCC representatives attended a Laurelhurst
Neighborhood Association meeting on November 24, 2009. Neighbors at the
meeting raised additional concerns, including general concerns about a nude
dancing establishment in their neighborhood. During the meeting, one of the
neighbors commented that there are two organizations near the above premises
that could be adversely affected if the Commission approved this application.
The two organizations mentioned were Full Life and Christian Outdoor
Leadership Training, a.k.a. COLT.

Several days following the meeting, I surveyed the immediate area of the above
premises. I visited the organization Full Life, located at 3331 NE Sandy Blvd,
which is one block west and within 500 feet of the above premises. According to
Rachael Bloom, President of Full Life, her organization offers a 10-day vocational
assessment program for mentally challenged youth and adult individuals. Full
Life also has a day program that operates from 8:00 a.m. to 5:00 p.m., five days
a week offering classes in art, science, music, life skills, and dance.

Full Life is not an elementary or secondary school or a children-oriented
recreational facility. And while it may enhance the lives of the individuals it
serves, it is not a facility as described in OAR 845-005-0326(2)(a).

I was unable to find the COLT organization. I found their web page and
contacted Ray Baier at their western Montana headquarters. According to Mr.
Baier, there is no COLT organization in the state of Oregon.

Applicant Operating Proposal

After informing the applicants of the past problems at La Fortuna, they provided
me with a 15 point operating plan designed to prevent the problems that occurred
at La Fortuna from re-occurring. The operating plan consists of the following:

Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 5 of 9

1. Will have on-site DPSST certified security staff at all times from 6:00 p.m.
to approximately 2:45 a.m., or until the parking lot is cleared. One DPSST
security staff will monitor the parking lots at all time and will increase to 4
to 8 depending on the size of the crowd.
2. Tracy Doss, a certified DPSST executive manager with over 20 years
experience in night club, restaurant and bar operations will oversee all
security matters.
3. DPSST security staff will conduct random parking lot checks every 10 to
20 minutes after 10:00 p.m.
4. Will always have a ratio of 1 DPSST security staff to every 25 patrons.
5. Will maintain a 16 camera DVR monitoring system for all areas of the
premises and premises parking lot.
6. Sherri Doss will be on-site four nights a week from 7:00 p.m. to 3:00 a.m.
7. No loitering, verbal/physical altercation, loud noise or other types of
disturbances or criminal activity will be tolerated inside or in the premises
parking lot area.
8. Will encourage and cooperate with Portland Police to do a walk through of
the premises during peak hours of operation.
9. Alcohol Monitors, Bartenders, Management, Servers and Security staff will
check for intoxicated persons, remove drinks of patrons if necessary.
10. Will maintain an incident log capturing dates, identifying information, staff
involvement, types of incidents, etc.
11. Will have an electronic I.D. checker at the entrance to detect false I.D.
12. No admittance of anyone after 1:30 a.m.
13. Will initiate a “Soft Closure” from 2:00 a.m. to 2:15 a.m. that includes last
call, and changing the music and lighting to facilitate an orderly exit.
14. All premises employees will be required to park their personal vehicles
bordering the perimeter fencing to create a sound and barrier to prevent
litter and loud noise from interfering with neighborhood livability.
15. Tracy Doss will be at the premises three nights a week (most likely
Wednesday & Thursday, & Saturday nights).

The applicant’s operating plan provides for the use of security that are DPSST
certified. Problems with disorderly activity at the premises when it was licensed
as La Fortuna occurred when the licensee did not have DPSST certified security.
Properly trained and certified security can help prevent those problems.

The applicant’s plan includes security staff to monitor the parking lot, security
cameras to monitor activity outside the premises, and frequent checks of the
parking lot after 10:00 pm. These measures should help the licensee respond to
and prevent noisy, unlawful, or disorderly patron activities in the parking lot.

If properly implemented, these measures will address some of the concerns
expressed in the citizen letters objecting to this application.
Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 6 of 9



CRITERION

ORS 471.313 – The Oregon Liquor Control Commission may refuse to
license any applicant under the provisions of this chapter if the
Commission has reasonable ground to believe the following to be true
(paraphrased):
(5) That there is a history of serious and persistent problems involving
disturbances, lewd or unlawful activities or noise either in the premises
proposed to be licensed or involving patrons of the establishment in the
immediate vicinity of the premises if the activities in the immediate vicinity
of the premises are related to the sale or service of alcohol under the
exercise of the license privilege.
Behavior which is grounds for refusal of a license under this section,
where so related to the sale or service of alcohol, includes, but is not
limited to obtrusive or excessive noise, music or sound vibrations; public
drunkenness; fights; altercations; harassment; unlawful drug sales;
alcohol or related litter; trespassing on private property; and public
urination. Histories from premises currently or previously operated by the
applicant may be considered when reasonable inference may be made that
similar activities will occur as to the premise proposed to be licensed. The
applicant may overcome the history by showing that the problems are not
serious or persistent or that the applicant demonstrates a willingness and
ability to control adequately the premises proposed to be licensed and
patrons’ behavior in the immediate vicinity of the premises which is related
to the licensee’s sales or service of alcohol under the licensee’s sale or
service of alcohol under the licensee’s exercise of the license privileges.

471.329 Serious and persistent problems involving noise as grounds for
discipline of licensee or applicant.
(1) For the purpose of determining whether there is a history of serious and
persistent problems involving noise under the provisions of ORS 471.313
(5) and 471.315 (1)(c), or whether the licensee maintains a noisy
establishment in violation of the provisions of ORS 471.425:
(a) Noise from the inside of a licensed premises located within the
boundaries of a city or county that has an ordinance regulating excessive
noise may be considered obtrusive or excessive only if the noise violates
the ordinance.





Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 7 of 9

FACTS RELATED TO CRITERION

1. On 2-26-06 at 2:45 a.m., security personnel at La Fortuna became
involved in an altercation with several patrons. Security personnel used
pepper spray to stop the disorder. One of the patrons was intoxicated.
OLCC compliance staff gave the premises manager VI on visible
intoxication and Disorder.

2. On 9-16-06 at 1:55 AM, a female patron was assaulted by her ex-
boyfriend across the street from the bar. The ex-boyfriend struck the
women in the back of the head with a beer bottle causing physical injury.
Security personnel immediately ran to the woman’s aid and telephoned
the police. OLCC compliance staff issued verbal instructions to the
licensee to ensure all security personnel are DPSST certified, and the
regulations regarding disorder.

3. On 01-20-07 at 2:15 AM, a Portland Police Officer saw a patron exit La
Fortuna restaurant and walk and stumble east on Sandy Blvd. The patron
went alongside of a building and urinated. The police officer contacted
the patron and notice he had slurred speech and a strong odor of alcohol
on his breath. The police officer took the patron to detox. OLCC
compliance staff contacted the licensee and issued verbal instructions for
sale/consumption of a visibly intoxicated person.

4. On 5-06-07 at 2:20 AM, Portland Police responded to the La Fortuna
Restaurant regarding an assault call. An employee telephoned the police
and said he was assaulted and sustained injury by an intoxicated patron.
The employee decided not to press criminal charges against the patron.
The police took the patron to detox for his own safety.

5. On 12-15-07 at 1:12 AM, a Portland Police Neighborhood Response
Team (NRT) Officer went to the premises to evaluate noise. The NRT
Officer noted he could hear music coming from the bar, especially the
bass tone from over 50 feet away.

6. On 01-05-08 at about 2:40 PM as patrons left the premises at closing, a
man was shot dead in the premises parking lot. Subsequent to the
homicide, OLCC compliance staff met with the licensee and fully
evaluated the circumstances leading up to the shooting and what if any
opportunity the club had to intercede in preventing the incident. OLCC
compliance staff concluded the licensee had failed repeatedly to ensure its
security personnel obtained DPSST certification.

Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 8 of 9

7. On 01-11-08 a Portland Police Officer responded to a noise complaint at
La Fortuna. Security staff immediately turned the volume of the music
down.

8. On 01-19-08 at 2:45 AM, a Portland Police Officer received a noise
complaint. “Due to a heavy caseload, the police responded at 3:30 AM
after the bar was closed. The Police found the business closed and the
area quiet.”

9. On 01-20-08 at 1:16 AM, Portland Police responded to a noise compliant.
The police officer looked at a noise meter used by the business and
observed .68 decibels. Under the City of Portland’s noise ordinances, the
legal limit after 10:00 PM is .55 decibels. The premises assistant manager
turned the music down.

10. On 02-20-08 at 12:28 AM, a Portland Police Officer responded to loud
music coming from the premises. The officer noted he could plainly hear
loud thumping from the bass of the music.

11. On 02-22-08 at 11:46 PM, Portland Police Officers responded to the La
Fortuna concerning a loud noise complaint. The police officer did not
determine there was excessive noise. The officer wrote “noise is kept
down for the most part.”

12. On 03-16-08 at 1:29 AM, a Portland Police Officer was dispatched to La
Fortuna Restaurant concerning a loud noise compliant. At 1:15 AM, the
officer parked his vehicle in the neighborhood approximately 167 feet from
the rear of the premise. The officer noted he could plainly hear the loud
thumping of bass from the direction of the premises. The office arrived at
the premises and confirmed that this was the same thumping bass he has
listened to in the neighborhood. The police referred the incident to the
NRT officer for follow-up.

13. The City of Portland has adopted noise ordinances under Title 18 of the
City Code. On 01-29-08, the City of Portland’s Bureau of Development
Service wrote a letter to El Poncho’s LLC and Poncho’s, Inc., property
owner and landlord of La Fortuna, advising of a noise violation for
amplified music, based on the 1-20-08 incident listed in fact #9 above.
None of the other incidents involving noise were charged as violations of
the City’s noise ordinances.

14. On 5-30-08, OLCC Compliance Staff wrote a Notice of Warning Ticket
(NWT) to the licensee of La Fortuna for History of Serious and Persistent
Problems, ORS 471.315(c).
Fat Jack’s, LLC
Fat Jack’s Saloon/Mynt Gentlemen’s Club
November 7, 2009
Page 9 of 9


ANALYSIS OF FACTS AS APPLIED TO CRITERIA

We must determine if there is a history of serious and persistent problems at the
licensed premises.

Seven of the 12 incidents (facts 5, 7, 8, 9, 10, 11, 12) listed above were
complaints from nearby residents about late night noise from amplified music.
The incidents listed in facts 5, 7, 8, 11, and 12 did not result in citations for
violations of the City Code regarding excessive noise. While the City of Portland
put the licensee on notice about a noise violation related to fact #9 above, the
City never issued a citation for violation of the City Code for excessive noise.

Since there were no citations issued by the City of Portland for violating its noise
ordinance, the noise complaints cannot be considered under History of Serious
and Persistent Problems under ORS 471.313 (5).

The remaining five incidents occurred during the 22 month period from 2/26/2006
and 1/5/2008. One incident involved a shooting and homicide in the premises
parking lot. This is a serious incident. Two incidents involved assaults that
resulted in injuries. These are serious incidents. One incident involved staff
security using pepper spray to stop disorderly activity. This is a serious incident.
Once incident involved public intoxication and an act of public urination. This is a
less serious incident. In all, there were four serious incidents at the premises
during a 24 month period.

The Commission has previously found that seventeen incidents in 24 months (10
involving illegal drugs) was a history of serious and persistent problems. The
Commission has also found that eight incidents in one year (five were serious),
and seven incidents in one year (three were assaults) was a history of serious
and persistent problems.

Although the five incidents in 22 months, with four serious incidents including a
homicide, are a cause for concern, the problems do not appear to rise to the level
of problems that the Commission has determined are serious and persistent in
other cases. The criterion does not apply.

CONCLUSION

The criterion does not apply.


____________
Charles L Ellis
.EGON LIQUOR CONTROL COMMISSh
LI CENSE INVESTI GATION REPORT
Date App lication Recei ved' 07-15-09
,
License Applied For : Type of Action:
FULL ON-PREMISES SALES, COMMERCIAL NEW OUTLET
ESTABLISHMENT
Applicant s 1: o Masterfile App licant 112: o Master file
FAT JACK'S LLC
Applicant 113: o Masterfile Applicant 114: o Mast erfile
New Trade Name: Liquor Liability Insurance: Phone II:
FAT JACK'S SALOON TBD 503-539-9670
For mer Tracie Name: Former Licensee : Former License Type:
Addr ess: City: County: Zi p:
3390 NE SANDY PORTLAND MULTNOMAH 97232
Mai ling Addre ss (if di fferent from abo ve): City : State: Zip:
Loca l Government: Public Notice Date: Checklist:
o 90 Day Temp, Autho rity-Exp:
City of Portland 05-27-09 [8J Ve rified Legal Entity( ies)
o 0 Clerk Brochures
Recommendation: No tification of Fac ilities within 500 Fee l:
[8J Law Orientation- Date: 05-14-09
o Favorab le
o Catering Pre-Approva l (Small)
[8J Unfavorable- See Report
Yes
o Catering Pr e- Appro val (La rge)
o Ne utral
o None Prov ided
o Tasting Privileges
Restrictions: Minor Posting:
o RVP Informati on Give n to Applicant
o Same Day Delivery Approval
None No.1
o Ne xt Day Delivery Approval
o Verifica tion of Zo ning
o Other:
Holds: License Process Office Use Only:
1. Fees
2 Verification of Funding
3. LLI
4. ASE by Sherri Doss
Server ' s Education Desig nee: Sherri Doss
Invest igat ors Recommendati on : Grant w/Letter of Caution to
Date of Birth: 06-21-1971
oPj/:te as
Date of Class:
-
/1 " -f (2L,

NP;l1e\ Charles L Ellis Date: if - 10 °f) q
Okay to Issue: Yes / No
Supervisor Refuse
"--.A

A
l Date:
Initial:
Summary Shce@NO Superv isor Sfgnature
I
bate:
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09-08-2001 10:09 T DOSS 7028220083
A OREGON LIQUOR CONTROL COMMISSION
Bl)SINESS INFORMATION
PAGE4
PlfJBSe Printor 'TYpe
Applicant Name: mt fll:ILs Phonel 6D?J) ..·qlD.ID
Trade Name 6lr=t:!19r!.!O'S CJ,a,g,,"olIooCb:....-. -----
Business Location u_d_. _
City: &-)1ood ZIP Code: C)ry 9.3 Ql
DAYS AND HOURS OF OPERATION
Business Hours:
Sunday Sf·ro.
Monday Jf'to
.Tuesday • to '. .'(Yl
Wednesday m to 3;!E_t 01 I
Thursday D Atn.
Friday m to Q1' *,'ll'1
Saturday to ,..... }l,m
Outdoor Area Hours:
Sunday to _
Monday to _
Tuesday to _
Wednesday to _
Thursday to _
Friday to _
Saturday to _
Theoutdoor area Is used for:
U Food service Hours: __, to _
o Alcohol service Hours: to _
CI Enclosed. how. __• _
The oxtoriar area Is adequately viewed and/or
supervised by Service Permittees.
_ (Investigator's Initials)
Seasonal Variations: 0 Yes [J No If yes, explain: _
ENTERTAINMENT
o LiveMusic
Recorded Music
)}( OJ Music
o Dancing
1iJ Nude Entertainers
Restaurant: -...__
Restaurant: :Go:

Lounge:.
Banquet:
Check all that apply:
o Karaoke
o Coin.aperated Games
)2!l Video Lot1ery Machines
o Social Gaming
o Pool Tables
o Other: _
Outdoor: _
Outdoor: _
Other (explain):
Total seating:.d!lifi-L/5
DAYS & HOURS OF LIVE OR OJ MUSIC
Sunday . to a:3D A··m
Monday -to dY3D A· m
Tuesday .(t).. to Ii .In .
Wednesday
Thursday • to , &4. m'
Friday to .' ((\
Saturday to 0 ;q. fl\
eieeuse ONLY
Investigator Verified 8eat,ng:hU (N)
eieeuse ONLY
Investigator Verified
9
Date: - ( .,.,
I undarsland If my answers are not true and the OLCCmay deny my license application.
Applicant Signature: =d. Date:--iJ..... (.z.O..... _
1·800-452·0LCC (6522)
www.oregon.govlolcc (ff1V. 12/07)
®
PAGE2
09-08-2001 10: es T DOSS 7028220083
---"---'-"- ._' .- --
A OREGON LIQUOR CONTROL COMMISSION
'C' FLOOR PLAN
• Your ftRQl' plan mudbo .uItm' ffAd gn fbi. fArm.
• U8& aS8pl1mte Floor Plan Formforeachlevel orfloor of thebulJdlng.
• ApplIcants must provide 8 &keten tI'lat shows thespecfflo 8rsa ofthe premise. (e.g. dlntng a_, bar, Joungs. Uchen and
reetroorns). FullOn-Praml_ ·(commerdal estabUlhmente) applIcants must alao shoW dining tables. see example onbaek.
1.800-452-0LCC (6522)
www.oT8f1On.gov/o/cc
Applicant Name
CItyenCi ZIPCod&
e
II
...._••OLCC USEONL'Y. .
MINORPOSTtMG ASSIONMENT(S)
1:£( !/et1L<}:e-)
Date: 1(( (7- cJ 7:

(tOY. 12107)