LICENSING ACT 2003

NOTICE OF APPLICATION FOR A PREMISES LICENCE/VARIATION*

OF PREMISES LICENCE

I, Applicant Name* have applied to Coventry City Council for a variation to

the premises licence for:

Premises Name*
Premises Address*
Premises Post Code*

The hours and relevant licensable activities which it is intended to provide

are as follows:

Supply of Alcohol (ON Sales, OFF Sales, ON&OFF Sales)* Sunday – Thursday XXam – XXpm*
Friday – Saturday XXam - XXpm*
Regulated Entertainment Sunday – Saturday XXam - XXpm*
Recorded Music Sunday – Saturday XXam - XXpm*
Provision of entertainment facilities Sunday – Saturday XXam - XXpm*
Provision of Late Night Refreshment Sunday – Saturday XXam – XXpm*

The register can be inspected at www.coventry.gov.uk or the application

may be viewed at The Licensing Authority, Coventry City Council, 024 7683
1888.

Any person wishing to make representations shall give notice by email to

licensing@coventry.gov.uk or in writing to the Licensing Authority, Coventry
City Council, PO Box 15, Earl Street, Coventry, CV1 5RR by XX/XX/XXXX

It is an offence to knowingly or recklessly make a false statement in

connection with an application. The maximum fine on summary conviction
is £5000.00

Please note that this is only an example of the notice that

needs to be displayed, it will need to be amended accordingly
to fit in with your application. (*delete or amend as
appropriate)