Application for Administrative Permit for an Unlicensed Nightclub	MUNICIPALITY OF ANCHORAGE Planning Department / Land Use PO Box 196650 Anchorage, AK 99519-6650
PETITIONER
Owner Name(s)
Enterprise Name	Business License Number
Mailing Address	City	State	Zip
Phone	Email

PROPERTY INFORMATION
Property Identification Number (000-000-00-000)	Zoning District
Site Address (include building number, street name, city, zip code)
Current Legal Description (Subdivision Name, Block #, Lot # or Township/Range and Lot #)

Anchorage Municipal Code Section 21.05.050D.8.c.ii regulates the location of unlicensed nightclubs and their proximity to protected land uses. All portions of the lot on which an unlicensed nightclub is located shall be 300 feet or more from the lot line of any property with a school or childcare, or that has a residential or TA zoning district designation.
YES	NO
Are minors or unaccompanied minors prohibited from the premises by law?
Is indecent material as defined in Title 8 of the Anchorage Municipal Code exhibited or proposed to be exhibited on the premises?
Are the premises licensed for the service and/or consumption of alcoholic beverages under AS 04.11.080?
Is the use any of the following?
a. Adult Bookstore
b. Dating or Escort Service
c. Massage Parlor
d. Adult Motion Picture Theater or Adult Mini-Motion Picture Establishment
e. Bar, Lounge, Package Store or the Like
f. Topless or Nude Dancing Establishment

REQUIRED ATTACHMENTS
Fee $590	Current Business License	Building floor plans with all uses labeled
Site plan or As-Built Survey Letter of Authorization from Property Owner

I have read and understand AMC 21.05.050D.8.c Use-Specific Standards for Unlicensed Nightclubs. I certify that the above information is correct to the best of my knowledge.

Property Owner / Applicant Signature	Date
Please Print Name

For assistance with this application, please call (907) 343-8332

TITLE 21 (LAND USE) OF ANCHORAGE MUNICIPAL CODE AVAILABLE ONLINE AT WWW.MUNI.ORG/PLANNING