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HomeMy WebLinkAboutUntitled Y 0MCRUSEONLY DATEFUZ& PERbUr Cost: $53.00 RECEIVED PLANNING&DEVELOPMENT SERVICES BUILDING&CODE REGULATIONS DIVISION APR 12 2019 2300 Virginia Avenue Ft.Pierce,FL 34982-5652 ST. Lucie County, Permitting TJZ4Q-1553 Fax 772-462-1578 APPLICATION FOR TEMPORARY USE PERMIT BUSINESS NAME: a�J E'��GY t�{/ti,� LLC NAME OF EVENT: _tyw O .c -e- ,"" eym LOCATION AM ADDRESS��Oi`F TEMPORY USE.EVENT.- fit 1 r p . A. �y CLQ -L G -'I 15 2 . PROPERTY TAF IDENTIFICATION#: � DESCRIPTION OF TEMPORARY USE: -O O U DATES OF THE EVENT: E-k oy ��� 2-0 APPLICANT'S NAME APPLICANT'S STREET ADDRESS: _ -FQ!4;ea K�z ^. CIT,Y..-,;; ^s :c C E;.,- STATE: t �fTr1 c`�CJS ZIP CODE: Lq �- WELL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES;V NO WILL THE EVENT HAVE A TENT(s):YES 4 NO (up to 900 square feet exempt from Sre permit) WILL THE HAVE BANNERS/PENNANTSMI AGS?YES LNO (OaV't per 300 Vnear 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,SE ON 8.02.023. -,--I PRINT APPLICANT'S NAME SIGNATURE OF APPLICANT STATE OF FLORIDA,COUNTY OF ACKNOWLEDGED BEFORE ME THIS IW'�— DAY OF u` I ,20LCA_, BY LC \ ,� d'�t X``C,�S WHO IS PEASONALLY KNOWN TO ME WHO HAS FRODUCED L_ AS IDENTIFICATION, _�...t_ . SIGMA OF NOTAR TYPE OR P NAME OF N Y.._ TnrrLE: O Y P C COMMISSION NUMBER: SLCiPDS 1011920 %kRYq Kelly Molloy 0 NOTARY PUBLIC o -+STATE OF FLORIDA Comm#GG23M4 s�yGE jExpires 9/38/2022 4 PERMISSION FROM OWNER OF PROPERTY _ RECEIVED ApR122019 • _ DATE: ST. Lucie Gtiun tY, Permitting AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE Lva-n �:VX 03 TO HOLD A TEMPORARY USE EVENT. PROPERTY TAX IDENTIFICATION P. 0 100 6 5 0 LEGAL DESCRIPTION OF PROPERTY: �I PROPERTY ADDRESS: CIO 0 S P + L.0 c► e I- T , OWNER INFORMATION: f PROPERTY OWNER'S NAME: / elUV-rn 5011, PROPERTY OWNER'S ADDRESS: CITY: STATE: ZIP CODE: fx PRINT OWNER'S NAME SIGNATURE OF OWNER STATEOF FLORIDA,COUNTY OF ACKNOWLEDGED BEFORE ME THIS �5.� DAY OF BY. Ie ��j Q k f-C WHO IS PERSONALLY KNOWN TO ME� ORWHO PRODUCED'k'1-7-1[ c��-I�[ o C AS IDENTIFICATION 1 Z.%G : FNOTARY TYPE OR PI NAME OF N Y Y PUBLIC COMMISSION NUMBER T4/cslwil lKelly Molloy NOTARY PUBLIC STATE OF FLORIDA " Comm#GG238684 Expires.9/18/2022 SLCPDS 10/194015 . RE-C EIVEV APR 12 2019 DBPR ABT-6029—Division of Alcoholic Beverages andFILE o acco sT. Lucie County, Permitting 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/iicensina.html 0. Transaction Type: Temporary Extension ❑ Amended Sketch [] Permanent Extension RON Licensee(as listed on alcoholic beverage license) EV Lcow 7 f Business Name(D/B/A) Z �&. ��rc,v� L Location Address (Street) (6Vs Cit tt County / State Zip Code FL 3 2 AlcoholBeverage License se Number Serls e Typee/C1ass Business Telephone Number Email Address(Optional 7-1 2-1-16]I-7z F Y- ext. 23 FOR TEMPORARY EXTENSIONS ONLY.- Date(s)of Extension: Zal ABT District Office Received/Date Stamp Auth.61A-5.0017 1 Location Street Address City/;aer Z�)r 1� /� County Zip Code �tfiv%. c/C FL Are there outside areas which are contiguous to the premises which are to be part of the premises sought to be licensed?" ❑Yes ❑ No ❑ 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. rA 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. Signed: L���-1 Title Date: J This approval is valid until__- I "�Cl Z�1 4o i 1 ¢F - a � _f pp �, �+ -/+ ,(,+fir FM at- 2= rya• o Py.� .,.Lr �S "5Ff m y'•p aye? s'i b7`y � Y ' `�' ^Y' s.:,ar FSS vxt.'azr ...ck'u '` k y G F�- � GjTJE COMT fl fb S 4 3 © ELS RESPR ,,TS , s ?�} _ OR DEQiARTM �'��IF�G�2IC�JL�T1yl���C�.IS,I�MER.SER�/1,CES: The above establishment complies with the requirements of the Florida Sanitary Code. Signed Date Title Agency This approval is valid until r Auth.61A-5.0017 2 ON � 01 -W- m 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 duty 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 the purposes 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: K2 "l understand that the premises must be restored to its original form at the conclusion of the authorized temporary event." STATE OFiMCk COUNTY OFA l 1� APPLICANT 9IGNATURE APPLICANT SIGNATURE The foregoing was( }Sworn to and Subscribed OR( }Acknowledged Before me this 1.3 Day of G1 �.. , 20_ia_, By t-Ok ,AT1711 who is{ }personally (print name(s)of person(s)making statement} known to me OR{ }who produced _� -a���� as identification. v K Commission Expires: Notary, c NOTARY PUBLIC c STATE OF FLORIDA r Com"GG238684 •�hCE I Auth.61A-5.0017 3 Business Name(D/B/A) 1. ' Yes ❑ No❑ Is the proposed premises movable or able to be moved? 2. Yes ❑ N5,U Is there any access through the premises to any area over which you do not have dominion and control? 3. Yes ❑ No.,M Are there more than 3 separate rooms or enclosures with permanent bars or counters? Is the business located within a Specialty Center"? If yes,check the applicable statute: 4. Yes ❑ FNoW ❑ 561.20(2)(b)1, F.S.or El 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 f, X 7'? ' Auth.61A-5.0017 4