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Lynn Extended Hours License Application

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					                                  City of Lynn, Commonwealth of Massachusetts
                                         APPLICATION ~~ NEW FILING ~~
                                           EXTENDED HOURS LICENSE

Please list your business information: (Please print all information)


Name of Business

Address of Business

Telephone Number of Business

e-mail address

Hours of Operation

Extension Requesting (please check one)                                     Extended hours through 2:00 AM                                         Extended hours for 24 hour service

Describe the services to be offered




Owner’s Name (Please Print)
Owner’s Street Address
Owner’s City, State, Zip

Owner’s Telephone Number




OWNER’S SIGNATURE                                                                                                                      DATE


                                                                                 OFFICE USE ONLY
                                              Personal & Property Taxes Paid with Workman’s Compensation Information.
                                              $50.00 Fee Paid
                                              Ward Councilor Notified Prior to Committee Meeting.
                                              Committee Approval                                     Hearing Date:



                                                                                                                                  Paid by:               Cash                    Check

                                                                                                                                         Clerk’s Initials:




C:\Users\Robert Wilson\Documents\Magic Briefcase\Web_Work\NS2_Lynn_Municipal\cityoflynn\cityhall_documents\clerk\forms\extendedhours\Application - Extended Hours License - New.doc
                                  City of Lynn, Commonwealth of Massachusetts
                                             RENEWAL APPLICATION
                                           EXTENDED HOURS LICENSE
Please update your business information: (Please print all information)
Name of Business

Address of Business

Telephone Number of Business

e-mail address
Hours of Operation

Extension Requesting (please check one)                                     Extended hours through 2:00 AM                                         Extended hours for 24 hour service

Describe the services to be offered




Owner’s Name (Please Print)
Owner’s Street Address

Owner’s City, State, Zip

Owner’s Telephone Number


               Please check box if there are no changes to Workman’s Compensation Information on File.




OWNER’S SIGNATURE                                                                                                                       DATE




                                                                                 OFFICE USE ONLY

                                              Personal & Property Taxes Paid
                                              No Change In Workman’s Compensation Information.
                                              Ward Councilor Notified Prior to Committee Meeting.
                                              $50.00 Renewal Fee Paid
                                              Committee Approval            Hearing Date:


                                                                                                                                  Paid by:                Cash                    Check

                                                                                                                                          Clerk’s Initials:


C:\Users\Robert Wilson\Documents\Magic Briefcase\Web_Work\NS2_Lynn_Municipal\cityoflynn\cityhall_documents\clerk\forms\extendedhours\Application - Extended Hours License - Renewal.doc
                       INSTRUCTIONS FOR
                 EXTENDED HOURS THROUGH 2:00 AM
                      AND 24 HOUR SERVICE
                        RETAIL/GAS/FOOD

A license must be obtained before operating the above businesses. The
license is valid from the date of issue through June 30th annually.

Steps to complete for License:

      1.            Application for each is $50.00 (new and renewed)
      2.            Cori Request Form (Criminal History)
      3.            Worker’s Comp Insurance Form and Property Tax Form
      4.            Notify Ward Councilor prior to Committee Meeting
      5.            Send application to Lynn Police for input prior to meeting

For New Applicants OR Applicants with New Locations:

      1. Contact Inspectional Services Department (Room 401) to make sure
         location does not need a Special Permit and is an allowed use.




C:\Users\Robert Wilson\Documents\Magic Briefcase\Web_Work\NS2_Lynn_Municipal\cityoflynn\cityhall_documents\clerk\forms\extendedhours\Instructions - Extended Hours
and 24 Hour.doc

				
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posted:10/4/2013
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