The Alaska 02 007 form is an application for a Teen Nightclub or Cultural Performance Venue Permit, essential for operating such venues in Anchorage. This form collects vital information about the applicant, business details, and compliance with local regulations. Completing this application accurately is crucial for ensuring a smooth approval process, so take the next step by filling out the form below.
The Alaska 02 007 form serves as an essential application for obtaining a Teen Nightclub or Cultural Performance Venue Permit in Anchorage. This document is crucial for anyone looking to operate such venues, as it ensures compliance with local regulations outlined in Title 10 of the Anchorage Municipal Code. Applicants must provide detailed information about themselves and their business, including contact details, business addresses, and any prior licensing issues. The form also requires the listing of individuals involved in the management or operation of the venue, ensuring transparency and accountability. Additionally, it addresses safety and compliance measures, asking applicants to outline their plans for crowd control, emergency evacuation, and adherence to curfew laws. The application process emphasizes the importance of community safety by requiring proof of insurance and a parking plan. By gathering this information, the form aims to create a safe environment for both patrons and the surrounding community, while also maintaining the integrity of cultural performances and teen events.
MUNICIPALITy OF ANCHORAGE
OFFICE OF THE MUNICIPAL CLERk
P.O. Box 196650 (632 W. 6th Ave., Ste 250)
Anchorage, Alaska 99519-6650
TEEN NIGHTCLUB/CULTURAL
PLEASE PRINT OR TYPE INFORMATION
PERFORMANCE VENUE
PERMIT APPLICATION
For Office Use Only
License No.________________
Date Issued________________
Application Date: __________________(LICENSES ARE NOT TRANSFERABLE)
I, __________________________________, hereby make application for a □ TEEN NIGHTCLUB □ CULTURAL PERFORMANCE VENUE PERMIT in
accordance with Title 10 of the Anchorage Municipal Code for the 20________, 20________ license years.
Applicant’s Name: ________________________________________________________________________ (Phone)__________________
Applicant’s Mailing Address: ________________________________________________________________ (ZIP) ____________________
Applicant’s Street Address: _________________________________________________________________ (ZIP) ____________________
Business Name: _________________________________________________________________________ (Phone)__________________
Business Mailing Address:__________________________________________________________________ (ZIP) ____________________
Business Street Address: __________________________________________________________________ (ZIP) ____________________
Have you ever had any license or permit revoked or suspended? □ YES □ NO If yes, give details including date(s), place(s) and reasons (attach additional pages as needed) ________________
______________________________________________________________________________________________________________________________________________________________
List the true name, residence address, daytime telephone number, and date of birth of each person directly engaged or employed in the management or operation of the business.
NAME
TITLE
RESIDENCE ADDRESS
PHONE #
BIRTHDATE
________________________________
__________________________
__________________________________________________________
______________________ _____________
OWNER/LANDLORD NAME ______________________________________________________________________________________________________________________________________
OWNER/LANDLORD ADDRESS___________________________________________________________________________________________________________________________________
If a partnership, list the true name, principal occupation, residence address, birth date and daytime telephone number of each partner and number of shares owned or controlled by each.
OCCUPATION
SHARES
______________________________
_________________________
____________________________________________________
_____________________
_____________ ________
The premises which is the subject of this application is in compliance with the Anchorage Municipal Code. Further I agree to comply with all laws, including, but not limited to, the noise control regulations in the conduct and operation of the TEEN NIGHTCLUB OR CULTURAL PERFORMANCE VENUE.
State of Alaska Business License No.____________________________ Date Issued_______________ Expiration Date__________________
(please attach a copy)
IF BUSINESS ENTITY, PLEASE COMPLETE:
State of Alaska
)
) ss:
Third Judicial District
__________________________________________, being duly sworn, deposes and says that he/she is the individual making the foregoing application
and authorized agent for this business that the answers to the questions and other statements contained in this application are true and complete to his/her knowledge.
Subscribed and Sworn to before me this _____ day of_______________, 20_______.
________________________________________
Signature of Applicant
_______________________________________
Notary Public
My commission expires: ____________________
FOR OFFICE USE ONLy
I.D. Furnished and Number
Fee Paid: $
Cash
Check No.
Receipt No.
02-007 Ver. 8_07 * Page 1 of 2 NOTE: THIS PERMIT CANNOT BE ISSUED UNTIL PROOF OF INSURANCE FOR THE PREMISES AND THE BUSINESS IS FURNISHED.
TEEN NIGHTCLUB/CULTURAL PERFORMANCE VENUE PERMIT APPLICATION
STATEMENT OF PROCEDURES FOR CROWD PROTECTION , TRAFFIC CONTROL AND CURFEW LAW COMPLIANCE
Business Name and Address: ___________________________________________________________________________________________
____________________________________________________________________________________________________________________
1.How will you identify when occupancy/capacity limits have been met? _________________________________________________________
2.How will entry be restricted when the premise is at capacity? _________________________________________________________________
3.What are your emergency evacuation plans? Who will be responsible for clearing the nightclub in case of emergency? ___________________
4 Identify the means to control or evict persons who pose a threat or hazard to others on the premises.__________________________________
5.What procedure is used to summon Police or Fire to an emergency or altercation? ________________________________________________
6.Describe procedures for admission. Where is the line located and what method will be used to prevent blocking of the sidewalk? ___________
7.Describe procedures for ensuring compliance with the Municipality’s curfew ordinance. ____________________________________________
STATEMENT OF PARKING PLAN AND DISTANCE FROM RESIDENTIAL BUILDINGS
1.How do you plan to provide parking for patrons? How many parking spaces will be provided? ________________________ Please attach a dia- gram.
_______________________________________________________________________________________________________________________
____________________________________________________________________
2.What is the distance from the location of the proposed TEEN NIGHTCLUB/CULTURAL PERFORMANCE VENUE to the nearest residential dwell- ing? __________________________Please attach a certification from the Department of Community Planning and Development that the location of
the proposed TEEN NIGHTCLUB/CULTURAL PERFORMANCE VENUE is more than 150 feet from the nearest residential dwelling. (An applicant is exempt from this requirement only if the TEEN NIGHTCLUB/CULTURAL PERFORMANCE VENUE had already been operating as of August 1, 1996.)
TO BE COMPLETED By TEEN NIGHTCLUB APPLICANTS ONLy
STATEMENT ON AGE RESTRICTIONS AND CONTROLS
1.How will you verify age of prospective patrons? How will you prevent prospective patrons under 14 or 21 or older from entering unless they fit in the ordinance’s exceptions?
2.How will you prevent entrance of persons for whom a parent or legal guardian has requested such limitation?
TO BE COMPLETED By CULTURAL PERFORMANCE VENUE APPLICANTS ONLy
EVIDENCE OF QUALIFICATION FOR CULTURAL PERFORMANCE VENUE PERMITS
State all evidence that shows the applicant can qualify for a permit as a cultural performance venue under AMC 10.55.005 B.
ATTACH ADDITIONAL SHEETS AS NEEDED
Applicant Signature ___________________________________________________________________________________ Title_______________________________________________________
Applicant Printed Name________________________________________________________________________________ Date ______________________________________________________
02-007 Ver. 8_07 * Page 2
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