Cannabis Consumption Area with On-Site Retail Application Form

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  5. Cannabis Consumption Area with On-Site Retail Application Form
Annual Licensing Fee: $2,500.00. All fees are non-refundable and must be paid via a cashier’s check made out to the Cannabis Control Division. Forms not completed in their entirety will be deemed incomplete by the division.
Cannabis Consumption Area with On-Site Retail shall mean and include a licensed cannabis retail premise where cannabis may be purchased (for on-site consumption only), and, unless licensed by the Lynn and Erin Compassionate Use Act, consumed by persons 21 years of age and over. A cannabis consumption area must be limited to one of the following uses:
  1. Consumption of cannabis by smoking, vaping, and ingesting edible products; or
  2. Consumption of cannabis edible products by ingestion only.
Smoking in a cannabis consumption area on a licensed premises shall be allowed only if the cannabis consumption area is in a designated smoking area or in a standalone building from which smoke does not infiltrate other indoor workplaces or other indoor public places where smoking is otherwise prohibited pursuant to the Dee Johnson Clean Indoor Air Act.
SECTION 1 - APPLICANT INFORMATION: Please provide the below business information for your cannabis business. ***THE APPLICANT MUST BE AN OWNER***
Business Organizational Structure: (check one):
Primary Business Address
Mailing Address (if different that primary address)
NOTE: Attach a detailed premises plan, including entrance, exit, video cameras, fire safety, consumption area, and lighting.
SECTION 2 - PRIMARY CONTACT PERSON This will be the contact person for any questions regarding the application.
Name
SECTION 3 – ATTESTATION/CERTIFICATION.
SECTION 3 – ATTESTATION/CERTIFICATION.
Printed Name
MM slash DD slash YYYY

Completed application, premises diagram, and license fee must be sent, or delivered, to the CCD address below.
For Cannabis Control Division Use Only:
MM slash DD slash YYYY
MM slash DD slash YYYY
Request approved:
MM slash DD slash YYYY
Director approval if required:
MM slash DD slash YYYY
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