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Home My WebLink AboutZoning Compliance/Spec Events-Temp Use I `8 PERMIT#: 18 1.1- O D'lq t OFFICE USE ONLY: DATE FILED: A o l Cost: S55.00 PLANNING&DEVELOPMENT SERVICES .L U CI BUILDING&CODE REGULATIONS DIVISION COUNTY 2300 Virginia Avenue F 0 Ii I 0 t� _ _w Ft.Pierce,FL 34982-5652 772-462-1553 Fax 772-462-1578 APPLICATION FOR TEMPORARY USE PERMIT BUSINESS NAME: .171 0.19v%_54 zCS L,G; l 1 t 9 . • � �t L�1 a NAME OF EVENT: 1-Z/,�1.►v� f�s� �� 1 �J b a) •�c1w'� c LOCATION AND ADD SS OF PO Y US EVENT: i1aQcC1 • n Ariz. 'k . h'�ti t 4z- PROPERTY TAX IDENTIFICATION#: 3 1 L. ' 21'333 -0001- O 00 in DESCRIPTION OF TEMPORARY USE: DATES OF THE EVENT: b2 C e.r'`U r Z i 2 0 k g • APPLICANT'S NAME: • sAzr PAtP-4;S APPLICANT'S STREET ADDRESS: r g D 43 R a CITY:.0-4-0 STATE: EL- - ZIP CODE: 3 Z 7C- WILL lGWILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES NO WILL THE EVENT HAVE A TENT(s):YES V NO (up to 900 square feet exempt from lire permit) WILL THE HAVE BANNERS/PENNANTS/FLAGS?YES V /NO (Only 1 per 300 linear feet;32 sq ft Max size) • I HEREBY ACKNOWLEDGE THAT THE ABOVE INFORMATION IS CORRECT AND AGREE TO CONFORM TO ST.LUCIE COUNTY LAND DEVELOPMENT CODE,SECTIO$ 02.0 Ste-r L. My z s it 4if, PRINT APPLICANT'S NAME S-711A OF APPLIC STATE OF FLORIDA,COUNTY OF SA—u,\C 1.e ACKNOWLEDGED BEFORE ME THIS (kh DAY OF NJ RMAX,t 320 , BY WHO IS PERSONALLY KNOWN TOME_, OR WHO HAS PRODUCED FL. L. AS IDENTIFICATION. ?-4) 1fc'tu IF Ile r Vcro h' SIGNATURE OF NOTARY TYPE OR PRINT NAME OF1gOTARY TITLE: NOTARY PUBLIC COMMISSION NUMBER: G D:1007 SLCPDS 10/19/2015 ,40142,,_ ELLEN VAUGHN :° A,State of Florida-Notary Public :3:4":-:•74 t Commission #GG 270079 I . ;".� My Commission Expires ame"sin ®eteber 22 2022 _ PERMISSION FROM OWNER OF PROPERTY ebca1/47.-. DATE: ( Wki AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE TO HOLD A TEMPORARY USE EVENT. PROPERTY TAX IDENTIFICATION 0: LEGAL DESCRIPTION OF PROPERTY: • PROPERTY ADDRESS: OWNER INFORMATION: PROPERTY OWNER'S NAME: PROPERTY OWNER'S ADDRESS: • CITY: STATE: ZIP CODE: PRINT OWNER'S NAME SIGNATURE OF OWNER STATE OF FLORIDA,COUNTY OF ACKNOWLEDGED BEFORE ME THIS DAY OF S ,20 BY WHO IS PERSONALLY KNOWN TO ME OR WHO HAS PRODUCED AS IDENTIFICATION. SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY TITLE: NOTARY PUBLIC COMMISSION NUMBER: seal SLCPDS 10/19/2015 • 8// /- 074 DBPR ABT-6003—Division of Alcoholic Beverages and Tobacco Application for One/Two/Three Day Permit or Special Sales License STATE OF FLORIDA DBPR Form DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6003 Revised 08/2013 if you have any questions or need assistance in completing this application,please contact the Division of Alcoholic Beverages&Tobaccot(AB&7)local district office.Please submit your completed application to your local district office at least(7)days prior to the first date of the event to insure the permit is issued by the event date. This application may be submitted by mail,or it can be dropped off. A District Office Address and Contact information Sheet can be found on AB&T's page of the DBPR web site at the link provided below. htto://wvvw.mviloridalicense.com/dboriabtidistrict officesilicensina.html SECTION-1 —CHECK TRANSACTION REQUESTED Transaction Type: El One/Twoffhree Day Permit 0 Special Sales License 'SECTION, PERMIT**LICENSE INFORMATION‘-• If the applicant is a corporation or other legal entity,enter the name and the document number as registered with the Florida Department of State Division of Corporations on the line below. FEIN Number Business Telephone Number E-Mail Address(Optional) 65-0312130 305-642-6255 deshaunh769@bellsoutlinet Full Name of Applicant(s):(This is the name the permit or license will be Issued in) Department of State Document# Teamsters Local Union No.769 Holding Corp, Inc. 713802 Business Name(D/B/A)or Name of Event Teamsters Local Union No.769 Location of Event(Street and Number) 8850 indrio Road,School House Park City County State Zip Code Fort Pierce St Lucie _ FL RAgsa Mailing Address(Street or P.O.Box) 3400 43rd Avenue,Suite 3 City State Zip Code Vero Beach FL 32961) Contact Person-This section is optional,see application instructions for details Contact Person Telephone Number Steve Myers 772-532-8122 ext. Email Address(Optional) deshaunh7690bellsouth.net Mailing Address(Street or P.O.Box) 3400 43rd Avenue,Suite 3 City State Zip Code Vero Beach Fl 37.9R(1 Date(s)Permit Desired December 2,2018 ABT District Office Received Date Stamp • Auth: 61A-5.0013,MC 1 SECTION SALES TAX _...,TO BE COMPLETED BY;THE:DEPARTMENT-OF-REVENUE: .__ ,`: Full Name of Applicant Organization TEAMSTERS.LOCAL UNION NO.769 HOLDING CORP.,INC. The named applicant for a license/permit has complied with the Florida Statutes concerning registration for Sales and Use Tax and has agreed to pay any applicable taxes due. Signed Date Title Department of Revenue Stamp: SECTION 4' ZONING • TOBE COMPLETED BY-THE ZONING;'AUTHORITY GOVERNING THE EVENT LOCATION Location of Event(Street and Number) 8850 INDRIO ROAD,SCHOOL HOUSE PARK City County FORT PIERCE ST. I LICIF The location • •' ith zoning requirements for the temporary sale of alcoholic beverages pursuant to this applicatio or •IThree Day Permit Signed / / Date 6 o Title —l3/!//1 .r ir1ii ii2 s"02. Note: College fraternities and sororities must meet certain additional conditions which can be found in the application Instructions and requirements. Auth: 61A-5.0013,FAC 2 SECTIONS ` DESCRIPTION QF'PREMtSES TO BE LICENSED .t' ' ,_,AB&T AUTHORIZED SIGNATURE'?REQUIRED Business Name(D/B/A)or Name of Event TEAMSTERS LOCAL UNION NO. 769 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 where the event will be held. A multi-story building where the entire building is to be licensed must show the details of each floor. rV ,({c� RDA_ c,� b�` w!K ,.t,n(-5°AG"' 4-0 siV S Auth: 61A-5.0013,FAG 3 L_ r 1 SECTION.6 AFFIDAVIT OFAPPLICANT ,z FOR;NON PROFIT CIVIC ORGANIZATION ALCOHOLIC BEVERAGE PERMIT r t t..,. ' ,1 _ , ,. ' . ... NOTARIZATION.;REQUIRED. . t , ...__ < . . r _. . Full Name of Applicant Organization "This is to certify that the applicant requesting the permit in the above and foregoing application Is a non-profit civic organization and that the permit,if used,will be used only by the organization making application,on the date(s) requested and at the location stated.By acceptance of this permit,we agree that the applicant organization,as the permit holder,is the ONLY entity that will receive any of the profits from the sale of alcoholic beverages on this permit This is to further certify that the applicant organization has not received more than three(3)permits within the calendar year,unless otherwise authorized by law,and acknowledge that the location may be inspected and searched during the time that the permit is issued and business is being conducted without a search warrant by authorized agents or employees of the Division of Alcoholic Beverages and Tobacco,the Sheriff,his Deputies,and Police Officers for purposes of determining compliance with the alcoholic beverage laws. I,the undersigned individual,hereby swear or affirm that I am an officer or authorized representative and am duly authorized to make the above and foregoing statements on behalf of the applicant organization.Furthermore,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 to the best of my knowledge." STATE OF FLORIDA COUNTY OF DADE JOSHUA ZIVALICH A LICANT HORIZ REPRESENTATIVE NAME • -LICAN THORIZED REPRESENTATIVE SIGNATURE The for:•,,Ing was( )Sworn to and Subscribed before me this 3 i Day of OCTOBER,20 2018 , By JOSHUA ZIVALICH who is(x)personally known to me (print name(s)of person making statement) OR( )who produced as identification. Ste/ Commission Expires: I -'l `A WZ.0 Notary Public 1 1 ��•0 Pi,� JOANNA BELANS I oncs Notary Public-State of Florida I �` • Commission#FF 989096 1, %S, --da.�' My Comm.Expires May 4.2020 I 1 #' fi ao'' Bonded through National Notary Assn. I i i I i Auth: 61A-5.0013,FAC • 4 i • SECTION 7 AFFIDAVIT OF APPLICANT FOR;SPECIAL SALES LICENSE NOTARIZATION REQUIRED _ - -- Full Name of Applicant Organization "I,the undersigned individual,or if a corporation,its authorized representative,hereby swear or affirm that I.am duly authorized to make the above and foregoing application for a special sales license which authorizes the sale of alcoholic beverages for period of up to three(3)days. I understand this license does not permit the sale of alcoholic beverages for consumption on the premises and only allows package sales in sealed containers and acknowledge that the location may be inspected and searched during the hours that the special sale is being conducted without a search warrant by authorized agents or employees of the Division of Alcoholic Beverages and Tobacco,the Sheriff,his Deputies,and Police Officers for purposes of determining compliance with the beverages laws. I swear under oath or affirmation under penalty of perjury as provided for in Sections 559.791,562.45,and 837.06, that the foregoing information is true to the best of my knowledge and that no other person or entity except as indicated herein has an interest in the special sales license and that all of the above listed persons or entities meet the qualifications necessary to hold this special sales license." STATE OF COUNTY OF NI / A APPLICANT/AUTHORIZED REPRESENTATIVE NAME APPLICANT/AUTHORIZED REPRESENTATIVE SIGNATURE The foregoing was( )Sworn to and Subscribed before me this Day of ,20 , By who is( )personally known to me (print name(s)of person making statement) OR( )who produced as identification. Commission Expires: Notary Public We Do Not Sale Alcohol Auth: 61A-5.0013,FAC 5 •ATTESTATION This form is to be completed by the alcoholic beverage license holder ONLY when the event of the non profit organization is being held at a location that is licensed by the Division of Alcoholic Beverages&Tobacco for the sale of alcoholic beverages. Note:This attestation must have the original signature of the alcoholic beverage license holder(only persons on file with the division may sign)and must be submitted by the non-profit group along with the application for the One/Two/Three Day Permit. Licensee: Business Name(DBA): License#: Series of Permanent License: Type: Contact Person Telephone Number ext. E-Mail Address(Optional) Name of Non-Profit Group: Date(s)of Event IMPORTANT A One/Two/Three Day permit is being requested for an event to be held on your licensed premises. During the event, no sales or service of alcoholic beverages may be made under your alcoholic beverage license in the area identified for use by the non-profit organization. Failure to comply will result in administrative charges being filed against your license. Signature of Licensee: Date: Auth: 61A-5.0013,FAC 6 'I I