Licensing Manager, Civic Centre, Carlisle CA3 8QG

Carlisle City Council

Licensing Manager, Civic Centre, Carlisle CA3 8QG

Tel: 01228 817523 Fax: 01228 817023

Email:

Application for a premises licence to be granted

undertheLicensingAct2003

PLEASEREADTHEFOLLOWINGINSTRUCTIONSFIRST

Beforecompletingthisformpleasereadtheguidancenotesattheendoftheform. Ifyouarecompletingthisformbyhandpleasewritelegiblyinblockcapitals. Inallcasesensurethatyouranswersareinsidetheboxesandwritteninblackink. Useadditionalsheetsifnecessary.

Youmaywishtokeepacopyofthecompletedformforyourrecords.

I/We

(Insertname(s)ofapplicant)

applyforapremiseslicenceundersection17oftheLicensingAct2003forthepremisesdescribedinPart1below(thepremises)andI/wearemakingthisapplicationtoyouastherelevantlicensingauthorityinaccordancewithsection12oftheLicensingAct2003

Part1–PremisesDetails

Postaladdressofpremisesor,ifnone,ordnancesurveymapreferenceordescription
Posttown / Postcode
Telephonenumberatpremises(ifany)
Non-domesticrateablevalueofpremises / £

Part2-ApplicantDetails

Pleasestatewhetheryouareapplyingforapremiseslicenceas Pleasetickasappropriate

a) / anindividualorindividuals* / pleasecompletesection(A)
b) / apersonotherthananindividual*
i. / asalimitedcompany / pleasecompletesection(B)
ii. / asapartnership / pleasecompletesection(B)
iii. / asanunincorporatedassociationor / pleasecompletesection(B)
iv. / other(forexampleastatutorycorporation) / pleasecompletesection(B)
c) / arecognisedclub / pleasecompletesection(B)
d) / acharity / pleasecompletesection(B)
e) / theproprietorofaneducationalestablishment / pleasecompletesection(B)
f) / ahealthservicebody / pleasecompletesection(B)
g)
g)a / apersonwhoisregisteredunderPart2oftheCareStandardsAct2000(c14)inrespectofanindependenthospitalinWales
apersonwhoisregisteredunderChapter2ofPart1oftheHealthandSocialCareAct2008(withinthemeaningofthatPart)inanindependenthospitalinEngland / pleasecompletesection(B)
pleasecompletesection(B)
h) / thechiefofficerofpoliceofapoliceforceinEnglandandWales / pleasecompletesection(B)
*Ifyouareapplyingasapersondescribedin(a)or(b)pleaseconfirm:
Pleasetickyes
Iamcarryingonorproposingtocarryonabusinesswhichinvolvestheuseofthepremisesforlicensableactivities;or
Iammakingtheapplicationpursuanttoa
statutoryfunctionor
afunctiondischargedbyvirtueofHerMajesty’sprerogative

(A)INDIVIDUALAPPLICANTS(fillinasapplicable)

Mr
/ Mrs
/ Miss
/ Ms
/ OtherTitle(forexample,Rev) /
Surname / Firstnames
Iam18yearsoldorover / Pleasetickyes
Currentpostaladdressifdifferentfrompremisesaddress
Posttown / Postcode
Daytimecontacttelephonenumber
E-mailaddress(optional)

SECONDINDIVIDUALAPPLICANT(ifapplicable)

(B)OTHERAPPLICANTS

Pleaseprovidenameandregisteredaddressofapplicantinfull. Whereappropriatepleasegiveanyregisterednumber. Inthecaseofapartnershiporotherjointventure(otherthanabodycorporate),pleasegivethenameandaddressofeachpartyconcerned.

Name
Address
Registerednumber(whereapplicable)
Descriptionofapplicant(forexample,partnership,company,unincorporatedassociationetc.)
Telephonenumber(ifany)
E-mailaddress(optional)

Part3OperatingSchedule

Whendoyouwantthepremiseslicencetostart? / DD / MM / YYYY
Ifyouwishthelicencetobevalidonlyforalimitedperiod,whendoyouwantittoend? / DD / MM / YYYY
Pleasegiveageneraldescriptionofthepremises(pleasereadguidancenote1)
If5,000ormorepeopleareexpectedtoattendthepremisesatanyonetime,pleasestatethenumberexpectedtoattend. /

Whatlicensableactivitiesdoyouintendtocarryonfromthepremises?

(Pleaseseesections1and14oftheLicensingAct2003andSchedules1and2totheLicensingAct2003)

Provisionofregulatedentertainment / Pleasetickanythatapply
a) / plays(iftickingyes,fillinboxA)
b) / films(iftickingyes,fillinboxB)
c) / indoorsportingevents(iftickingyes,fillinboxC)
d) / boxingorwrestlingentertainment(iftickingyes,fillinboxD)
e) / livemusic(iftickingyes,fillinboxE)
f) / recordedmusic(iftickingyes,fillinboxF)
g) / performancesofdance(iftickingyes,fillinboxG)
h) / anythingofasimilardescriptiontothatfallingwithin(e),(f)or(g)
(iftickingyes,fillinboxH)
Provisionoflatenightrefreshment(iftickingyes,fillinboxI)
Supplyofalcohol(iftickingyes,fillinboxJ)

InallcasescompleteboxesK,LandM

Plays
Standarddaysandtimings(pleasereadguidancenote6) / Willtheperformanceofaplaytakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsforperformingplays(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheperformanceofplaysatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Films
Standarddaysandtimings(pleasereadguidancenote6) / Willtheexhibitionoffilmstakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsfortheexhibitionoffilms(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheexhibitionoffilmsatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Indoorsportingevents
Standarddaysandtimings(pleasereadguidancenote6) / Pleasegivefurtherdetails(pleasereadguidancenote3)
Day / Start / Finish
Mon
Tue / Stateanyseasonalvariationsforindoorsportingevents(pleasereadguidancenote4)
Wed
Thur / Nonstandardtimings. Whereyouintendtousethepremisesforindoorsportingeventsatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Fri
Sat
Sun

Boxingorwrestlingentertainments
Standarddaysandtimings(pleasereadguidancenote6) / Willtheboxingorwrestlingentertainmenttakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsforboxingorwrestlingentertainment(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesforboxingorwrestlingentertainmentatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Livemusic
Standarddaysandtimings(pleasereadguidancenote6) / Willtheperformanceoflivemusictakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsfortheperformanceoflivemusic(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheperformanceoflivemusicatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Recordedmusic
Standarddaysandtimings(pleasereadguidancenote6) / Willtheplayingofrecordedmusictakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsfortheplayingofrecordedmusic(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheplayingofrecordedmusicatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Performancesofdance
Standarddaysandtimings(pleasereadguidancenote6) / Willtheperformanceofdancetakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsfortheperformanceofdance(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheperformanceofdanceatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Anythingofasimilardescriptiontothatfallingwithin(e),(f)or(g)
Standarddaysandtimings(pleasereadguidancenote6) / Pleasegiveadescriptionofthetypeofentertainmentyouwillbeproviding
Day / Start / Finish / Willthisentertainmenttakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Mon / Outdoors
Both
Tue / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Wed
Thur / Stateanyseasonalvariationsforentertainmentofasimilardescriptiontothatfallingwithin(e),(f)or(g) (pleasereadguidancenote4)
Fri
Sat / Nonstandardtimings. Whereyouintendtousethepremisesfortheentertainmentofasimilardescriptiontothatfallingwithin(e),(f)or(g)atdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sun

Latenightrefreshment
Standarddaysandtimings(pleasereadguidancenote6) / Willtheprovisionoflatenightrefreshmenttakeplaceindoorsoroutdoorsorboth–pleasetick(pleasereadguidancenote2) / Indoors
Outdoors
Day / Start / Finish / Both
Mon / Pleasegivefurtherdetailshere(pleasereadguidancenote3)
Tue
Wed / Stateanyseasonalvariationsfortheprovisionoflatenightrefreshment(pleasereadguidancenote4)
Thur
Fri / Nonstandardtimings. Whereyouintendtousethepremisesfortheprovisionoflatenightrefreshmentatdifferenttimes,tothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Sat
Sun

Supplyofalcohol
Standarddaysandtimings(pleasereadguidancenote6) / Willthesupplyofalcoholbeforconsumption–pleasetick(pleasereadguidancenote7) / Onthepremises
Offthepremises
Day / Start / Finish / Both
Mon / Stateanyseasonalvariationsforthesupplyofalcohol(pleasereadguidancenote4)
Tue
Wed
Thur / Nonstandardtimings. Whereyouintendtousethepremisesforthesupplyofalcoholatdifferenttimestothoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Fri
Sat
Sun

Statethenameanddetailsoftheindividualwhomyouwishtospecifyonthelicenceasdesignatedpremisessupervisor:

Name
Address
Postcode
Personallicencenumber(ifknown)
Issuinglicensingauthority(ifknown)

Pleasehighlightanyadultentertainmentorservices,activities,otherentertainmentormattersancillarytotheuseofthepremisesthatmaygiverisetoconcerninrespectofchildren(pleasereadguidancenote8).

Hourspremisesareopentothepublic
Standarddaysandtimings(pleasereadguidancenote6) / Stateanyseasonalvariations(pleasereadguidancenote4)
Day / Start / Finish
Mon
Tue
Wed
Nonstandardtimings. Whereyouintendthepremisestobeopentothepublicatdifferenttimesfromthoselistedinthecolumnontheleft,pleaselist(pleasereadguidancenote5)
Thur
Fri
Sat
Sun

MDescribethestepsyouintendtotaketopromotethefourlicensingobjectives:

a)General–allfourlicensingobjectives(b,c,dande)(pleasereadguidancenote9)

b)Thepreventionofcrimeanddisorder

c)Publicsafety

d)Thepreventionofpublicnuisance

e)Theprotectionofchildrenfromharm

Checklist:

Pleaseticktoindicateagreement
/ Ihavemadeorenclosedpaymentofthefee.
/ Ihaveenclosedtheplanofthepremises.
/ Ihavesentcopiesofthisapplicationandtheplantoresponsibleauthoritiesandotherswhereapplicable.
/ IhaveenclosedtheconsentformcompletedbytheindividualIwishtobedesignatedpremisessupervisor,ifapplicable.
/ IunderstandthatImustnowadvertisemyapplication.
/ IunderstandthatifIdonotcomplywiththeaboverequirementsmyapplicationwillberejected.

ITISANOFFENCE,LIABLEONSUMMARYCONVICTIONTOAFINENOTEXCEEDINGLEVEL5ONTHESTANDARDSCALE,UNDERSECTION158OFTHELICENSINGACT2003,TOMAKEAFALSESTATEMENTINORINCONNECTIONWITHTHISAPPLICATION.

Part4–Signatures (pleasereadguidancenote10)

Signatureofapplicantorapplicant’ssolicitororotherdulyauthorisedagent(seeguidancenote11). Ifsigningonbehalfoftheapplicant,pleasestateinwhatcapacity.

Signature
Date
Capacity

Forjointapplications,signatureof2ndapplicantor2ndapplicant’ssolicitororotherauthorisedagent(pleasereadguidancenote12). Ifsigningonbehalfoftheapplicant,pleasestateinwhatcapacity.

Signature
Date
Capacity
Contactname(wherenotpreviouslygiven)andpostaladdressforcorrespondenceassociatedwiththisapplication(pleasereadguidancenote13)
Posttown / Postcode
Telephonenumber(ifany)
Ifyouwouldpreferustocorrespondwithyoubye-mail,youre-mailaddress(optional)

Notes for Guidance

Describe the premises, for example the type of premises, its general situation and layout and any other information which could be relevant to the licensing objectives. Where your application includes off-supplies of alcohol and you intend to provide a place for consumption of these off-supplies, you must include a description of where the place will be and its proximity to the premises.
Where taking place in a building or other structure please tick as appropriate (indoors may include a tent).
For example the type of activity to be authorised, if not already stated, and give relevant further details, for example (but not exclusively) whether or not music will be amplified or unamplified.
For example (but not exclusively), where the activity will occur on additional days during the summer months.
For example (but not exclusively), where you wish the activity to go on longer on a particular day e.g. Christmas Eve.
Please give timings in 24 hour clock (e.g. 16:00) and only give details for the days of the week when you intend the premises to be used for the activity.
If you wish people to be able to consume alcohol on the premises, please tick ‘on the premises’. If you wish people to be able to purchase alcohol to consume away from the premises, please tick ‘off the premises’. If you wish people to be able to do both, please tick ‘both’.
Please give information about anything intended to occur at the premises or ancillary to the use of the premises which may give rise to concern in respect of children, regardless of whether you intend children to have access to the premises, for example (but not exclusively) nudity or semi-nudity, films for restricted age groups or the presence of gaming machines.
Please list here steps you will take to promote all four licensing objectives together.
The application form must be signed.
An applicant’s agent (for example solicitor) may sign the form on their behalf provided that they have actual authority to do so.
Where there is more than one applicant, each of the applicant or their respective agent must sign the application form.
This is the address which we shall use to correspond with you about this application.