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HomeMy WebLinkAboutZoning Compliance/Use Permit OFFICE USE ONLY: DATE FILED: / 'a/`L ! PERMIT#: Cost: :$55 PLANNING&DEVELOPMENT SERVICES �- - F BUILDING&CODE REGULATIONS DIVISION r $ 2300 Virginia Avenue be _ Ft. Pierce,FL 34982-5652 7 772-462-1553 Fax 772-462-1578 IAN 9 6 2018 -_._- . _ __:..: _ ..___-_ ___- __:-- -_:_-APPLIC--ATION�FOR=T=EMPORARY-USE=-PERMIT==• --__ BUSINESS NAME: II`L !� s J b' 0��� Aolu 6r NAME OF EVENT: LOCATION AND ADDRESS OF TEMPORY USE �EVENT: PROPERTY TAX IDEN'T'IFICATION#: DESCRIPTION OF TEMPORARY USE: A 9 DATES OF THE EVENT: kAlt C:(1 16� 17; 1 ,12 t I f APPLICANT'S NAME: 04"--f 1-F,W15-7T, • � , g�'l��' APPLICANT'S STREET ADDRESS: 100 A) CITY: � l� STATE: ZIP CODE:54 •.6 7 WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE: YES 'k WILL THE EVENT HAVE A TENT(s): YES (�NO (up to 900 square feet exempt from fire permit) WILL THE HAVE BANNERS/PENNANTS/FLAGS?YES /NO__X _(Only 1 per 300 linear feet;32 sq ft mag size) I HEREBY ACKNOWLEDGE THAT THE ABOVE INFORMATION IS CORRECT AND AGREE TO CONFORM TO ST.LUCIE COUNTY LAND DEVELOPMENT CODE,SECTIO pRi'cY ,ro5 PRINT APPLICANT'S NAME S(G TURE OF APPLICANT STATE OF FLORIDA,COUNTY OF J� •C L ACKNOWLEDGED BEFORE ME THIS DAY OF By � iPS _WHO IS PERSONALLY KNOWN TO MEe� OR WHO HAS PROD ACED AS IDENTIFICATION. _ OU—'L-169- I&STY) acs-(--l 0-- IN Q kCc-) SIGNATURIs OF NOTARY TYPE.OR PRINT NAME OF NOTARY TITLE: NOTARY PUBLIC COMMISSION NUMBER: SLCPDS 10/19/2015 0" ;'avp " CARLA NELSON Notary PublicState of Florida Commission#FF 965535 � Ally Comm.Expires Feb 28,2020 'rnun PERMISSION FROM OWNER OF PROPERTY DATE: RSI AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE VI Afl.�°� TO HOLD A TEMPORARY USE EVENT. PROPERTY TAX IDENTIFICATION LEGAL DESCRIPTION OF PROPERTY: N �` I.. W-57 PROPERTY ADDRESS: OWNER INFORMATION: q PROPERTY OWNER'S NAME: PROPERTY OWNER'S ADDRESS: W OL S, <)CET Av,_ CITY: %/91�'� y�✓ C°i�� STATE: r^ ZIP CODE: ; l fly/ PRINT OWNER'S NANIrE SIGNATURE Of OWNER STATE OF FLORIDA,COUNTY OF • (l_ tle ACKNOWLEDGED BEFORE ME THIS S' DAYOF �• 120 i BY r-- � � � � �'.� irk G 11 �lV WHO IS PERSONALLY KNOWN TO ME - ��- ! `��o CSV OR WHO HAS PRODUCED AS IDENTIFICATION. SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY TITLE: NOTARY PUBLIC COMMISSION NUMBER: [-W 7My RLA NELSON lic-State of Floridasion#FF 965535 Expires Feb 28,2020 SLCPDS 10/19/2015 DBPR ABT-6029—Division of Alcoholic Beverages and Tobacco II. Application for Extension or Amended Sketch.of.Licensed Premises... STATE OF FLORIDA DBPR Form DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6029 Revised 0212013 If you have any questions or need assistance in completing this application, please contact the Division of Alcoholic Beverages& Tobacco's(AB&T)local district office. Please submit your completed application and required fee(s) to your local district office. This application may be submitted by mail, through appointment, or it can be-dropped off A-District Office Address and Contact Information-Sheet can be- found on AB&T's web site at the link provided below: http://www.myfloridalicense.com/dbpr/abt/district offices/licensing.html SECTION 7 CFECI�TRANSACTLON: EQUESTED,.. Transaction Type: ® Temporary Extension ❑ Amended Sketch ❑ Permanent Extension EGTION:2 MOW FBusiness listed on alcoholic beverage license) 4 " s.4 f.A? S' C1dg , me(D/B/A) Location Address (Street) City County State Zip Code G dJ L FL Alcoholic Beverage License Number Series Type/Class Business Telephone Number Email Address (Opt! al 7 Zd29 ext. 91 A Ip� ) i If ,sof FOR TEMPORARY EXTENSIONS ONLY. Date(s)of Extension: P - ABT District Office Received/Date Stamp Auth.61A-5.0017 1 i a I .. ..: .. _ <������ � -�. �^� �,��� _•��, ��1�.�'�ION����`Z�,�I�NG�I�F�PRC1i`/ICL "�� �x# `,�W�,����;a y����.��f���;; .. ,�,�.a�a t< ? _05 "'�3�.�v �- �. �,n,� ^ cr.T,„ Y.z ?a.�. .fir-�a<€^�: kwr� "'s !h� � ���..:��:"",..,, �€R�'��''Ss36 r-•� � "" a �0}3 �1�It11PL`�ETB�B�Y-�'�HI��ON�NG AUTH�RIT�1��C�OUBkNtNGFYO�tR��USIN�S��0��4TI01� ; 4 4T �s s �fiannl alesp` r nnent'ote�n orareenslQn of Geiser Locatign Street Address t �r. © -,/a Cit Countyl y- Are CodeFL there outside areas which are contiguous to the premises which are to be part of the premises sought __ to be licensed? ❑ The PERMANENT extension of the licensed premises as shown in the sketch complies with zoning requirements for the sale of alcoholic beverages pursuant to this application: �. The TEMPORARY extension of the licensed premises as shown in the sketch complies with zoning requirements for the sale of alcoholic beverages pursuant to this application. en Signed: Title: 417 %54 a 1` Date: This approval is valid r 2t7 z a u r . SEC�TIbNA4 HEALTtJr== x � r � � TO�BE GIfPETID Bh1FT�HExD1ES1 ?It OFH ?i'�54It}32BSTAi� 1TSkf< � II � � �� ` ��� �' � OR�DEPIo► T � �C���AGRI�I�I.,`�'zU,RB�$�t": NSUMERSfR1�[CE� "�""�"��s�, ���'� The above establishment complies with the requirements of the Florida Sanitary Code. Signed Date Title Agency This approval is valid until Auth.61A-5.0017 2 SI=CTI(�N 5. AFFID/A1/IT:OF ApPL�CAMT MaT` RIZATION.F3�QUIRD Business Name(D/B/A) "I, the undersigned individually, or if a registered legal entity for itself, its officers and directors, hereby swear or affirm that I am duly authorized to make the above and foregoing application and, as such, I hereby swear or affirm that the attached sketch is a true and correct representation of the extended licensed premises and agree that the place of business may be inspected and searched during business hours or at any time business is,being conducted on the premises without a search warrant by officers of the Division of Alcoholic Beverages and.Tobacco_,,the_sheriff,his.deputies, and police officers for thepurposes of determining, compliance with the beverage and cigarette laws." I swear under-oath or affirmation under penalty of perjury as provided for in Sections 559.791, 562.45 and 837.06, Florida Statutes that the foregoing information is true and correct." If applying for a temporary extension,check the box to confirm the following statement: X "I understand that the premises must be restored to its original form at the conclusion of the authorized temporary event." STATE OF COUNTY �' t'C J a PLICANT SIGNATURE APPLICANT SIGNATURE i The foregoing was( ) Sworn to and Subscribed OR( )Acknowledged Before me this 'J Day of , 20 , Byd I who is ( personally (print name(s) of person(s).making statement) r known to me OR( )who produced as identification. Ca 01- C"_) L0VA Commission Expires: C� Notary' Public V PVCARLA NELSON 3. Commission#FF 96553 ,x a•� My Comm.WINS Feb 28,2020 Auth.61A-5.0017 3 SECTION 6—DESCRIPTION OF PREMISES TO BE LICENSED Business Name (D/B/A)- 1. Yes ❑ NojV Is the proposed premises movable or able to be moved? 2. Yes ❑ No Is there any access through the premises to any area over which you do not have dominion and control? 3. Yes EI No bI Are there more than 3 separate rooms or enclosures with permanent bars or counters? 4. Yes °` No"--' Is the business located within a Specialty Center? If yes,check the applicable statute: ❑ 561.20(2)(b)1, F.S.or❑ 561.20(2)(b)2, F.S. Neatly.draw a floor-plan of-the-premises-in ink, including sidewalks and:other-outside_areas-which•are contiguous-to-the- - premises,walls,doors,counters,sales areas,storage areas, restrooms,bar locations and any other specific areas which are part of the premises sought to be licensed. A multi-story building where the entire building is to be licensed must show the details of each floor. . . I i i G�A, I im Ii Auth.61A-5.0017 4 6— g wz NAM A .1.S7, :�> T�'r�•'����',.,d-�' ',:�', �5,+ •.,t": 'i. �I rh tt.' {� '.ry .d .�%,.\`' .dN• '{7,. •1'd ,'t+' �...r�S' � E.. � '^-1'. ,j, _'�'i:,. !.f`-.n TM ly I LIN 011 Nil ow, r. �YgEbtl �1�1 173V im I . . .1 , - m) WN .vv wgz,,� v SI "' _.) RE T'I", I e, go. VJ1iiu gy g,"'. 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