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HomeMy WebLinkAbout(0101) AD20-00003 Application.pdfFORT WORTH. Request to the City Council M& C# AbZ - 000 0 Z ALCOHOL DISTANCE APPEAL APPLICATION (Please Print or Type) Name of Establishment I a 4g7'i ^"'� `y rQs 1,ucation 3 EAR Z Wdale {Fa f ► AR#71TG 7&&6 Legal Description •Cgk C 11-ke Ai hk:*i _ Block/Ab A 5 Lot/Tr Owner of Establishment V oSe T1 ' C 10 n.201 S Owner Signatur P 4 !% ae �% ' 12Gr f �e.1�P< Owner Address '024- S OfflVt�A-1- Ave City 4z�T WU1e7'11} Zip r%(O /O Owner Phone No oI'72' gql 5;5'94-2"d Ph No Email Name of School or Church <300 It / 1000 ft from the establishment ryJdl+r�L G Has the School, Church, etc. been contacted or do you know of any opposition to this request? Yes❑ Noss Is Alcohol- Consumption: PREMISE r OFF PREMISE W Type of TABC License(s) J { _ �! LV 'Ll1 7s o CanVrV Type of Business VV/ =t Setback Measurement / Distance Request Is hui! g leased? YesV NoF- Building Owner / Lessor name&20a 4t17and1Pz. Lessor Signatui _ LessorAddress CO� City Gn 'Lip �f%OOg9 Lessors P hone No. L42-0t;q7733 2^d Ph No 6P9i&3Ot"*7%—Email 6UanaheR.�?17&Vowal/ Cal Applicant Name (if other than Owner) Applicant Address City Applicant Phone No. 2"d Ph No Email ALCOHOL DISTANCE APPEAL PROCESS & REQUIREMENTS: ;ip ❑ Building Inspector, Ken McGowen (817-392-7834), (Rejection Letter and Measurements required PRIOR TO SUBMITTING). 62( Processing time is approximately 4 weeks and the request will be heard at the appropriate City Council Hearing. Hearings are held at City Hall on Tuesdays and the applicant is required to be present. 5d Summery of hardship and/or reason for requesting a DISTANCE APPEAL is recommended. ❑ Staff to provide Early Notifications to surrounding HOA's, Schools, etc., within a '/ mile buffer of subject property. ❑ Staff will notify all property owners, neighbors, within a 300' buffer of subject property (You may contact Council Members prior to the hearing to see if they approve or have received opposition for your case at hitu:llfortwort htexas.aovl ** At the hearing, "Speaker Request forms" must be completed and turned in to the staff desk upon addressing the City Council. According to the City Council Rules of Procedures, individual citizen presentations shall be limited to three minutes, and group presentations shall be limited to six minutes. At the Mayor's discretion, time limits may be reasonably extended. To speak before the meeting you may call 817-392-6150, fax 817-392-6196 or http://fortworthtexas.gov)** Application Fee Received Date Hearing Date Case # Code 124 $500.00 By. City of Fort Worth, 200 Texas Street, Fort Worth, TX, 76102 Planning and Development / Zoning Department. for more information please call 817-392-2733 or 817-392-8130 10/11/2017 www.fortwo rthtexas.gov F 7�T CITY OF FORT WORTH, TEXAS ■ ALCOHOL PERMIT LOCATION VERIFICATION INSTRUCTIONS: Applicant is to complete all requested information down to the double line and also attach a copy of the completed T.A.B.C. application fomi. Name of Applicant: G ( Phone: LL _ s l V 1 Name of easiness: 6~` j t �'ts I( �� ' � s _ Phone: Application Address:_ �T t l f Lip: L' Legal Description of Property: Lot: �Block: AddWon: CC Is there or has been a T.A. B.C. license on the properly before? Yes, No If Yes, when does it or did It expire?_ In addition to the sale of alcoholic beverages, please provide an accurate statement of all other business or entertainment activities to be conducted at the application address: ; NOTICE: Approval of the processing form does not imply that the location/building is in compliance with all applicable ordinances. This form Is only for distance check and zoning use. Consult with the Department of Development, lower level of City Hall, regarding all other requirements before investing any time or money. \#.R**Rf.RM.f....... *....fif... .... ,.,.#.............. ,.,...•...I■R►............ .ap.R,...f.....*.i.**...... H..H.f.................................. A. FORCITY USE ONLY **#...*.f.*1...................*..................*..............,,............,..........,...,....r.*.....,.,.....+.. Date Received:��,' LT Mapso No.: p l' \Council District Zoning on the propertZ_L��Mk �t i� � Latievz Is the location Within 4RnrV Al a it Yhq giva Church? Yes V No Public school? Yes _ No Public hospital? Yes _ No Private school? Yes _ No 4150 E. ROSEDALE • MOUNT HERMON Is the location within 1 000'feet of a private school protected by resolution? Yes_ Noe[ _ Comments: - - BUILDING INSPECTORS CERTIFICATION I hereby certify that I have personally inspected the property described above and my comments are: 1. The use as described by the applicant is allowed in this zoning? Yes -NZ (by rightV, by legal nonconforming_) No__ 2. The locatio is within 300' of a church, public school or public hospital? 3. This location is within 1,000' of a private school protected by resolution? 4a. If the zoning allows this use and the distance check complies, check the Yes box to the right and continue processing. b. If zoning does not allow this use, check the No box, clear the paperwork and stop he processing. c. It the zoning allows this use but the distance does not comply, check the No box, clear the paperwork, and forward to the Director for review. Verified by: JAMES QUINN (Inspector Signature and Printed Name) Director's Cammants Yes _VNo— Yes _ No.)[ OK to issue Yes ❑ . No Date: 03/25/2020 _ oK to Issue: Yes Q No 0 Director's Signature: _ _�__ Date: (This approval not needed if the above box is marked YES) 1R RRf ff.*.R...f..i1..#......... **...i.RR*R,\R*i*fR*1**fi1r....f..*****.*#R....R...f.f.irRR..1..l ....... *.}R... *.... *.*..*...... RR♦fiRR**fif.\..i.#f*##Rf Rf RR T.A. B.C. application processed by;— _ � �_-. Date: C)lerk, City Secretary Rev 8/02 Dear Alcohol Distance Appeal Committee, I write to you today asking, for you to please reconsider the approval of an Alcohol License for Taqueria Las Esmeraldas. Taqueria Las Esmeraldas is a convenience store with a grill, we serve authentic Mexican Food. Alcohol will only be sold and to be consumed on the premises upon an Approval. The reason why our license was turned down was to lacking 1 OFT from Mount Herman Church we currently stand at 290FT away from Mount Herman Church. The minimum required is 300FT. I would like to say there is currently a convenience store across the street who sells alcohol West of our location. Along with a liquor store Northwest of our location across the street. I have tried to reach out to the church, I've been unsuccessful to reach anyone due to the COVID-19 outbreak. However, I am not aware of the church being against the City of Fort Worth issuing an Alcohol License to this location. The reason why I am comfortable to say this is because an alcohol license has been issued before to this location but has expired. Our address is 4163 E Rosedale St. Fort Worth, TX 76105. Denial to our license will cause major hardships to our business economically, I humbly ask for your reconsideration. I appreciate your time and I ask that you please consider approval. Diana Hernandez 04/ 15/2020 FORT WORTH:, Alcohol Distance Check Not a valid permit until status is ISSUED Permit: AD20-00062 Application Date: 03/16/2020 Status: Accepted Date Issued: Permit Technician: Joseph Sigman Address: 4163 E ROSEDALE ST Legal Description: EAST GATE CENTER ADDITION Block 1 Lot A8A Mapsco: 78M Insp District: 7 Council District: 8 Zoning: E Description of work: Proj/Business Name: LAS ESMERALDAS Applicant: DIANA HERNANDEZ, LAS ESMERALDAS, 4163 E ROSEDALE ST FORT WORTH, TN 76105 Property Owner: GONZALES, JOSE M 5424 BON NELL AVE FORT WORTH TX 76107-6, 14 76107-6714 Alcohol Distance Check 1 $50.00 Total Fee $50.00 Balance $0.00 1 hereby affirm that the information contained herein is true and correct to the best of my knowledge, and agree to conform to all regulations of the City of Fort Worth as described in the Fort Worth Municipal Code. I understand that failure to comply with these provisions may result in the revocation of this permit. Signed: Date: Sexually Oriented Business (initials) Yes No Local permit or license fees may apply to a business that sells alcoholic beverages in the City of Fort Worth. Please check with the Revenue and Collections Division of Financial Management Services to inquire about applicable fees. Signed: Date' 202,C) To SCHEDULE INSPECTIONS CALL (817) 392-6370 AA-20-003 COUNCIL DISTRICTS 2 - Carlos E. Flores - 3 - Brian Byrd 4 - Cary Moon - 5 - Gyna Bivens - 6 - Jungus Jordan 7 - Dennis Shingleton 8 - Kelly Allen Gray - 9 - Ann Zadeh Location Map 2.5 5 10 Miles Created: 6/22/2020 10:02:42 AM Area Zoning Map Applicant: Jose Gonzalez by Diana Hernandez Mapsco: 78M Commission Date: 7/20/2020 _ Subject Area 300 Foot Notification N 87.5 175 350 Feet Created: 6/22/2020 10:02:38 AM Accela Automation8 X 1512 Robinwood Drive, Fort V X „ Accela Automation13 X Q All Inspections by Insp - Repor X 4 500D E Rosedale St - Google I x + — X (f" Q i google.com/maps/placef5GOG+E+Rosedale+St,+Fort+Worth,+TX+76105f@32.7312714 97.2626496,73m/data=!3m1!lea!4m5!3m4!lsOx864e7a8bcbd4d23l:Dxb4O5dfO... �+ Apps CFW CFWnet.org City of... m Ed Young Fellowshi... 0 Suggested Sites ❑ Imported From IF G Gmail YouTube 9 Maps © Summary YouTube Q Maps © New Tab G Gmail77 » M 4 � � i � 'ir CF} � ■ .. • • ■ L + • 1 , -6J X . r t r;0; # t � Measure distance Click on the map to add to your path Total distance- 264-77 ft (80.70 m) ■ ` TEXAS ALCOHOLIC BEVERAGE COMMISSION 7•TO/ri 1141 ing Nuxi,re'.•xrs rF 1°nrhk'finl! !'nn+uuenifirr• �l'1 [Ylas- ON-PREMISE PREQUALIFICATION PACKET L-Old (9/2019) Submit this packet to the proper governmental entities to obtain certification for the type of license/permit for which you are applying as required by Sections 11.37, 11.39, 11.46(h), 61.37, 61.38, 61.42 and Rule §33.13 Contact your local TABC office to verify requirements of Sections 11.391 and 61.381 as you may be required to post a sign at your proposed location 60-days prior to the issuance of your Iicenselpermit. All statutory and rule references mentioned in this application refer to and can be found in the Texas Alcoholic Beverage Code or Rules located on our website. www.tabc.texas.govJJawslcode and rules.asp LOCATION INFORMATION -- 1. Application for: Original ❑ Add Late Hours Only License/Permit Number ❑ Reinstatement ❑ Reinstatement and Change of Trade Name License/Permit Number ❑ Change of Location ❑ Change of Location and Trade Name License/Permit Number 2. Type of On -Premise License/Permit BG Wine and Beer Retailer's Permit El Mixed Beverage Late Hours Permit ❑ BE Beer Retail Dealer's On -Premise License ❑ Ml Minibar Pennit ❑ 11L Retail Dealer's On -Premise Late Hours License ❑ Ce Caterer's Permit ❑ BP Brewpub License FE Food and Beverage Certificate ❑ V Wine & Beer Retailer's Permit for Excursion Boats PE Beverage Cartage Permit ❑ V, B Mixed Beverage Permit ❑ RM Mixed Beverage Restaurant Permit with FB ❑ 0 Private Carrier's Permit —arew ubs BP with a BG only ❑ E Local Cartage Permit - Winelaeer retailers (BG) Only 3. Indicate Primary Business at this Location Zr Restaurant ❑ Sporting Arena, Civic Center, Hotei ❑ Bar ❑ Grocery/Market ❑ Sexually Oriented ❑ Miscellaneous 4. Trade Name of Location (Name of restaurant, bar, store, etc.) L ftS i 9 11 Cle7j 5. Location Address City County State Zip Code : vl'i- 4 T-7 to 1 V Y 6. Mailing Address qgy State ' Zip Code V\j tDY-+ 0,:bY4,i 1 )C - 7 4 t i. Business 15one No. Alternate Phone No. 2. 0 - C1 (e E-mail Address Z � `� -17 r ? - o 5 e SrrLa r-c �� � c t> OWNER. INFORMATION'?'�'�-i 8. Type of Owner ❑ Individual ❑ Corporation ❑ City/County/University ❑ Partnership Limited Liability Company ❑Other ❑ Limited Partnership ❑ Joint Venture ❑ Limited Liability Partnership ❑ Trust _ 9. Owner of Business/Applicant (Name ofCorporation, L etc.) 9LC, I Ci L I s G SYi'�K .. �r •I r, f % . PRIMARY CONTACT PERSON The primary contact person should be a person who can answer questions TABC may have about the application. The contact phone and email are mandatory and must be active and updated regularly. If additional information is needed, it will be requested from his contact person. DeIa s in res p o n d 1 ng to reg uests m ay d el ai r the p rocess1n g and a p provaI of your.[icon se! ermit. 10. Contact Person: Relation to Business: (] t t-,q C r' i n i� r Phone {mandatory): ['] Z � � 3 Email (mandatory): /14 A e y- � � MD-4 �. [al. TABC DATESTAM P Page 1 of 5 Form L-ON (0912019) 11. Are you, the applicant a veteran -owned business? ❑ Yes ❑ No 12. Are you, the applicant a Historically Underutilized Business (HUB)? ❑ Yes ❑ No 13. As indicated on the chart, enter the individuals that pertain to your business type: For additional space, use Form L-01C Individualllndividual Owner Limited Liability Company/All Officers or Managers Partnership/All Partners Joint VentureNenturers Limited Partnership/All General Partners Trust/Trustee(s) Corporation/All Officers City, County, University/Official Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title MEASUREMENT INFORMATION Section 109.31 et seg.- -- -- 14. Will your business be located within 300 feet of a church or public hospital? ❑ Yes []No NOTE: For churches or public hospitals measure from front door to front door, along the property lines of the street fronts and in a direct line across intersections. 15. Will your business be located within 300 feet of any private/public school, day care or child care facility? ❑ Yes ❑ No 15.a If "YES," are the facilities located on different floors or stories of the building? ❑ Yes ❑ No NOTE: For private/public schools, day care centers and child care facilities measure in a direct line from the nearest property line of the school, day care center or child care facility to the nearest property line of the place of business, and in a direct line across intersections. NOTE: For multistory building: businesses may be within 300 feet of a day care center or child care facility as long as the facilities are located on different floors of the building. If located on or above the fifth story of a multistory building: measure in a direct line from the property line of the privy telpublic NOTE: school to property line of your place of business in a direct line across intersections vertically up the building at the property line to the base of the floor on which your business is located. 16. Will your business be located within 1,000 feet of a private school? ❑Yes ❑ No 17. Will your business be located within 1,000 feet of a public school? ❑Yes ❑ No 60-DAY SIGN 18 If required under Section 11.391 and 61.381, enter the exact date the 60-Day sign was posted Exact Date (MMIDDIYYYY) at your location. 3 -2r0 ALL APPLICANTS 19. IF YOUR LOCATION IS NOT WITHIN THE CITY LIMITS, CHECK HERE 1, the applicant, have confirmed I am not tocated in the city limits of any city, therefore, city certifications are not required. COMPLETE THE FOLLOWING CHECKLIST BEFORE SUBMITTING YOUR APPLICATION Per Sec. 102.01, a tied house is defined as any overlapping ownership between those engaged in the alcoholic beverage industry at different levels of the three-tier system. No person raving an interest in a permit issued by TABC may secure or hold, directly or indirectly, an ownership interest in a business on a different level. All required forms have been completed. ❑ Yes ❑ No I have reviewed all forms to ensure they are complete. ❑ Yes ❑ No I have obtained all required local and state certifications (pages 3-5). ❑ Yes ❑ No All application packets have been notarized. ❑ Yes ❑ No Phone numbers and email address for Contact Person are up to date. ❑ Yes ❑ No All additional documentation as required by the application packets is attached ❑ Yes ❑ No If required, out of state criminal history checks are attached (PHS #7). ❑ Yes ❑ No ❑ NIA Certification of publication in local newspaper has been completed (page 5). ❑ Yes ❑ No ❑ NIA A copy of the newspaper publication is attached (page 5). ❑ Yes ❑ No ❑ N/A Page 2 of 5 Form L-ON (0912019) WARNING AND SIGNATURE. IF APPLICANT- IS SHOWN AS: WHO MUST SIGN: ; _ P�rUa2rsh]p_ Individual Owner Partnership Partner Co oration offirar Limited PartnershipGeneral Partner• . Limited Liability Partnership I General Partner _ s Limited Liabi] V companY �� 1 offieeriManaer WARNING: Section 101.69 of the Texas Alcoholic Beverage Code states: "...a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to he sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years." I, UNDER PENALTY OF LAW, HEREBY SWEAR THAT I HAVE READ ALL THE INFORMATION PROVIDED IN THE APPLICATION AND ANY ATTACHMENTS AND THE INFORMATION IS TRUE AND CORRECT. I ALSO UNDERSTAND ANY FALSE STATEMENT OR REPRESENTATION IN THIS APPLICATION CAN RESULT IN MY APPLICATION BEING DENIED AND/OR CRIMINAL CHARGES FILED AGAINST ME, I ALSO AUTHORIZE THE TEXAS ALCOHOLIC BEVERAGE COMMISSION TO USE ALL LEGAL MEANS TO VERIFY THE INFORMATION PROVIDED. PRINTr n �]SIGN NAME �� � `S i L� _ HERE TITLE Before me, the undersigned authority, on this i5v 1 day of I , 2010, the person whose name is signed to the foregoing appli n person y appeared and, duly sworn by me, states under oath that he or she has read the said application and t t I the fa erein set forth are true and correct. 51G�i LEENZSCHf[A' '0S HER KWARY PUBLIC WTARYPUELIC&TATEOFTE%A9 SEALNOTRRY OM OMMI Dt 995 76' CERTIFICATE OF CITY. SECRETARY (FOR MB, RM & V) Section 1.1.37 _ I hereby certify on this W� day of f , 2Q that the location for which the license/permit is sought is inside the boundaries of this city or town, in a "wet' area for such licenselpermit, and not prohibited by charter or ordinance in reference to the sale of such alcoholic beverages. SIGN HERE SEAL City Secretary/Clerk city CERTIFICATE OF CITY SECRETARY (FOR BG .& BE) Section 11:37.& 61.37 TEXAS I hereby certify on this day of 20, that the location for which the licenselpermit is sought is inside the boundaries of this city or town, in a "wet" area for such license/permit, and not prohibited by charter or ordinance in reference to the sale of such alcoholic beverages. Election for given location was held for: ❑ legal safe of all alcoholic beverages ❑ legal sale of all alcoholic beverages except mixed beverages ❑ legal sale of all alcoholic beverages including mixed beverages ❑ legal sale of beer/wine (17%) on -premise AFTER Sept. 1, 1999 ❑ legal sale of beer/wine (14%) on -premise BEFORE Sept. 1, 1999 OR 1F ABOVE DOES NOT APPLY: Be advised the location must have had two election passages per Section 25.14 or Section 69.17 of the TABC Code. One for beer and wine off -premise and one for mixed beverage. ❑ legal sale of beer and wine for off -premise consumption only AND EITHER: ❑ legal sale of mixed beverages I OR ❑ legal sale of mixed beverages in restaurants by food and beverage certificate holders (applicant must apply for FB with BG or BE) SIGN HERE TEXAS City Secretary/Clark City I—S-E A �' -- - -- Page 3 of 5 Form L-ON (09/2019) F_ CERTIFICATE OF CITY SECRETARY FOR LATE HOURS LICENSE/PERMIT (LB &BL) -- Chapters 29 & 70 et seq. _ I hereby certify on this day of 20 , that one of the below is correct: ❑ The governing body of this city has by ordinance authorized the sale of mixed beverages bpWoen midnight and 2:00 A.M.; or ❑ The governing body of this city has by ordinance authorized the sale of beer between midnight and A.M.; or ❑ The population of the city or county where premises are located was 500;000 or more according to the 22°c, Decennial Census of the United States as released by the Bureau of the Census on March 12, 2001; or [j The population of the city or county where premises are loeatdd was 800,000 or more according to the last Federal Census (2010). SIGN HERE TEXAS City Secretayy]Clerk City SEAL CERTIFICATE OF COUNTY CLERK (FOR MB, RM & V) - Section 11.37 hereby certify on this day of , 20 , that the location for which the license/permit is sought is in a "wet" area for such license/permit, and is not prohibited by any valid order of the Commissioner's Court. SIGN HERE County Clerk SEAL CERTIFICATE OF COUNTY CLERK (FOR BG & BE) Section 11.374 61.37 I hereby certify on this day of , 20 , that the location for which the license/permit is sought is in a "wet" area and is not prohibited by any valid order of the Commissioner's Court. Election for given location was held for: ❑ legal sale of all alcoholic beverages ❑ legal sale of all alcoholic beverages except mixed beverages ❑ legal sale of all alcoholic beverages including mixed beverages ❑ legal sale of beer/wine (17%) on -premise AFTER Sept. 1, 1999 ❑ legal sale of beer/wine (14%) on -premise BEFORE Sept. 1, 1999 OR IF ABOVE DOES NOT APPLY: Be advised the location must have had two election passages per 25.14 or 69.17 of the TAB Code. and one for mixed beverage. ❑ legal sale of beer and wine for off -premise consumption only AND EITHER: ❑ legal sale of mixed beverages OR ❑ legal sale of mixed beverages in restaurants by food and beverage certificate holders (applicant must apply for FB with BG or BE) SIGN HERE County Clerk SEAL �I�1FL'I<�1 One for beer and wine off -premise COUNTY Page 4 of 5 Form L-ON (0912019) CERTIFICATE OF COUNTY CLERK FOR LATE HOURS LICENSE/PERMIT (LB & BL) Chapters 29 & 70 et sect hereby certify on this day of 120 that one of the below are correct: ❑ The Commissioner's Court of the county has by order authorized the sale of mixed beverages between midnight and 2:00 A.M.; or ❑ The Commissioner's Court of the county has by order authorized the sale of bebetween midnight and A.M.; or J ❑ The population of the city or county where premises are located was 500,000 or more according to the 22nd Decennial Census of the United States as released by the Bureau of the Census on March 12, 2001; or ❑ The population of the city or county where premises are located was 800,000 or more according to the last Federal Census (2010). SIGN HERE " my Clerk SEAL -� COMPTROLLER OF PUBLIC ACCOUNTS CERTIFICATE _— Section 11.46 (t?)& 61.42 b) COUNTY This is to certify on this day of 20 , the applicant holds or has applied for and satisfies all legal requirements for the issuance of a Sales Tax Permit under the Limited Sales, Excise and Use Tax Act or the applicant as of this date is not required to hold a Sales Tax Permit. Sales Tax Permit Number Outlet Number Print Name of Comptroller Employee Print Title of Comptroller Employee SIGN HERE FIELD OFFICE SEAL. PUBLISHER'S AFFIDAVIT (FOR MB, LB., RM, BP, BG, BE, BL & V) Section 11.39 and 61.38 Name of newspaper City, Count Dates notice published in daily/weekly II ATTACH PRINTED newspaper [MMIDDNYYY] Publisher or designee certifies attached notice was published in newspaper stated on dates shown. 1 COPY OF THE Signature of publisher or designee NOTICE HERE Sworn to and subscribed before me on this date MM/DDIYYYY Hover over to see example Signature of Notag Public SEAL Page 5 of 5 Form L-ON (0912019) ' lti Ali'(irlr TEXAS ALCOHOLIC BEVERAGE COMMISSION z�¢ir - ��y. Ti•rrnry 1!rlryi�+,� 13in,rrr.��e.� eC- 1'm�r•rri+rg ('urnmr+niiier OWNERSHIP INFORMATION Continued for Prequalification Packet L-C 1 C (09/2019) _ LOCATION INFORMATION 1. Trade Name of Location 2. Location Address F 90 SLkl ZZ s City County ?LTx State Zip Code 16,16.5- OWNER INFORMATION 3. Type of Owner ❑ Individual ❑ Corporation ❑ City/County/University ❑ Partnership Limited Liability Company ❑ Other ❑ Limited Partnership Joint Venture ❑ Limited Liability Partnership ❑ Trust Last Name f' First Name (An Ck— MI Title Last Name First Name MI Title Last Name First Name Ml Tit e Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title Page 1 of 1 Form L-OIC (0912019) The City of Fort Worth FTI; Qe�elopment Services 200 Texas Street Fort Worth, TX 76102 (817) 392-2222 Fax (817) 392-8116 http://fortworthtexas.gov DevC ustomer5ervice@FortWorthTexas.gov Receipt Record Information Record Number Record Name AD20-00062 LAS ESMERALDAS Fee Information Item# Description 006279001 Payment Information Method Credit Card - VISAIMCIDiscover Account Code 10100-0062000-4401017 CommentlReference No. visa-6139 PAYMENT RECEIPT: 1271805 CASHIER: SIGMONJ DATE: 03/16/2020 Site Address APN 4163 E ROSEDALE ST 129884 Invoice# 1248223 Total Fee Amount Amount $50.00 $50.00 Transaction Amount $50.00 Total Amount: $50.00 FORTWORTH. Planning and Development Department Certification Form For Primary Uses With Accessory On -Premise Alcohol Consumption The undersigned owners and for managers of the'610'� fur\(Xp �- (Legall NNamj% - of Primary Use/Business) located at `1� `P �ZOVOCAI A ���a�Idress . further known as Lo`_ Cs " ���'l (legal description), located in the __ zoning district, hereby agree to operate the Business in conformance with the Comprehensive Zoning Ordinance and its Princ'fples as outlined herein. These Principles are that: 1. CI SYYZS2 VGl Gt (Business name) will be the primary business and sales of (product or service) will constitute more than 50 percent [50%] of the income of the daily receipts of the business. 2. Alcohol will not be sold when _f�CSCY"kj U— (product or service) is not available for sale or no event is being held. Serving of the liquor will be an accessory use. 3. The owner shall maintain documentation -of revenue receipts from the sale of alcoholic products and non-alcoholic products or service and shal[ provide a clear accounting of the percentage of income from each. The documentation shall be submitted to the City of Fort Worth for review upon request. The revenue receipts shall be submitted to the City within 10 business days of the request to review unless additional time is determined to be necessary by the City. 4, In the case of an entertainment venue, ticket sales may be sold in advance or on site, but shall be for the event only. Ticket Cover charges intended for the entrance into an establishment only and not directly tied to the admission into a specific event or act shall Rev. 2/27/2012 be considered income with the alcohol sales and will not count toward the ticket sales. "House" bands or other regularly performing bands shall not be considered "events" for the purposes of this regulation. It is understood that the failure to operate under the conditions outlined above will cause a Zoning Violation subject to penalties as assessed in the Zoning Ordinance of the City of Fort worth and cancellation of any licenses granted by the City of Fort Worth. .ti f Signed on this date `_� ,20 cJ caner Operator Printed Name b\' 0,ach, Address -�JN LJ4k Phone. U'�-20Cl-- J]r?22> Email C . ar C 1 III1114 I T TE,� J'•- PAY A BC- 0 � Notary Public Certification Cn OF �. Y i0 525 �. �► 0. 8 i `L����►�� City Contact: Planning and Development Department 1000 Throckmorton Lower Level 817-392-2222 Rev. 2/27/2012 P r-/ A �4 W 4 ■. B REAKFAS T DESAYUNO TRADICIONAL 5.50 2 Huevos Al Gusto, Papa Rayado, Tocino o Jamon con 2 Rebanadas de Pan. 2 Eggs, Hashbrown, Bacon/Ham with 2 slices of bread. CIII LAQUILES RO.IOS 7.99 Fried Corn Tortillas Simmered with our specialty sauce, topped with Queso Fresco a side of Refried Beans and 2 Eggs. I-IUEVOS ItANCI-IEROS 7.99 2 Eggs Simmered with our Ranchero Sauce ❑ side of Refried Beans and Potatoes a la Mexicana. BREAKFAST BURRITOS $2.50 Huevo/Cliorizo, Huevo/Damon, Huevo/Tocino, Huevo/Papa, Huevo A la Mexieana, Huevo/Machaea BURRITOS $4.99 Florir Tortilla filled with a thin layer of leans, cilantro/onion, cheese and yotir choice of the following meats below; Carnitas Shredded Pork Pastor Spicy Pork Asada Beef Barbacoa Picadillo Ground Beef Fa jita De Pollo Chicken Fajita *Constr+nerArlvisory Cottszitnl)tion of a ndercooked turret, potel", eggs, orseq`ood may inereise the risk off;i'ood-borne illnesses, Alert your ser-wr if you have special dietary requirements. ■ / 1 ► ■ % ■ I LUNCH E NCHILADAS ROJAS 8.99 3 Enchiladas with Queso Fresco Covered in Potatoes, Shredded Chicken and Queso Fresco with ❑ Fresh Side Salad. t{ LAUTAS 8.99 3 Chicken Flautas with a Side of Rice and Beans with ❑ Fresh Side Salad. ASADO CHILE ROJO 8.99 Pork Bites Smothered in our Salsa, with a Side of Rice and Beans with Fresh Corn Tortillas. CHULETAS DE PUERCO 9.50 Grilled Pork Chop smothered in onions with a side Rice and Beans and Fresh Corn Tortillas. EAJITAS DE RES 11.99 Fresh Fajitas Smothered in Onion, Bell Pepper and Tomatoes with a side of Rice and Beans, Fresh Side Salad and with Fresh Corn Tortillas. COCTEL DE CAMARnN MO Fresh Shrimp Cocktail with Onions, Tomatoes, Cilantro, Avocado in Tomato Juice. TACOS $1 Asada/Beef, Barbacoa, Pastor/Pork, Carnitas/Shredded Park ,Fajitas de Pollo/Chicken Fajitas. TACOS $2 Firsh Corn 7a,^tillas Asada/Beef, Barbacoa, Pastor/Pork, Carnitas/Shredded Pork ,Fajitas de Polio/Chicken Fajitas, Lengua/Tounge, Tripas/Crtinchy Intestine. Saturday & Sunday Only MENUDO 8.99 Traditional Mexican Soup of Pancita with Hominy in a red pepper broth with your choice of Fresh Tortillas or Bread. Small Plate $7.99 POSOLE 8.99 Mexican Style Soup Beef with Hominy in a Red Pepper Sauce with your Choice of Fresh Tortillas or Bread. Small $7.99 CALDO DE RES 8.99 Beef Stew with Vegetables ❑ side of Rice and Fresh Corn Tortillas. Coca Mexican $2.75 jarritos/Sangria $2.50 Aguas Frescas $2.50 Coffee $0.99 Michelada 9.99 Preparada lista para su Cerveza de Gusto! (Sin Alcohol) Ll�ltIalI[III 5.50 Fruta Fresca Todos los Dias! Elote Entero Con Crema y Cereza ' �'YLa.►Ica.c�. 5 Con Chamoy AD20-00062 - LAS ESMERALDAS Update Reset Cancel Help Inspection detail Checklist Conditions (0} Documents (0) Alternate ID Inspection Type - Scheduled Date AD20-00062 195 Distance Inspection 103f25f202O Status * Inspection Date Total Time Turned Dawn 0312512020 0 30 ❑ Billabl Department Current Deparment Inspector Current User Dev Inspectors V I James Quinn Resu It Comment R Standard Comments SIDE. DOOR IS 265-275 FEET AWAY AND FRONT DOOR IS @290 FT FROM DOOR OF CHURCH MT. HERNDON AT 4150 E_ ROSEDALE- Inspector James Quinn 317-223-1395 check spelling Related Inspections Record Type * Development/Alcohol Distanc Record ID * 20D EV-000 00-0 000 H Created By ACA No Request Date Request Time 03l24f2020 0 11 31, AM Requestors Phone Number