Petitioner: Application information
Applicant Information
| Manager / Owner Name |
Test
|
| Premises Address |
101 Broadway Chelsea, MA
|
| Applicant Phone |
---
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| Applicant Email |
---
|
| Days of operation |
Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
|
| Hours of operation |
24 hours a day; closed Sundays
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Renewals (please complete all fields if this is an application for a renewal)
| If this is a renewal, has any information changed from your original license application? |
No - renewal without changes
|
Entertainment Device Categories
| Number of Jukeboxes |
1
|
| Number of Karaoke machines |
1
|
| Enter 1 if dancing by entertainers/performers is offered |
1
|
| Enter 1 if dancing by patrons will occur |
1
|
| Enter 1 if light shows are offered |
1
|
| Enter 1 if floor shows are offered |
1
|
| Number of radios |
3
|
| Number of TV screens |
10
|
| Enter 1 if live shows are offered |
1
|
| Enter 1 if use of amplification |
1
|
Billiard Table Information (enter 0 if no billiard tables are included)
| Number of Billiard Tables |
0
|
Pool Table Information (enter 0 if no pool tables are included)
| Number of Pool Tables |
0
|
| Are tables owned by the petitioner? |
No (fill in following fields)
|
Video Amusement Devices - provide the following information for each device (upload a separate sheet if necessary)
| Total Number of video amusement devices |
0
|
| Name of amusement device |
n/a
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| Owner status |
Purchased
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