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HomeMy WebLinkAboutApplication for Zoning Compliance - Use Permit OFFICE USE ONLY: DATE FII ED: 1 Cost. $55.00 PLANNING&DEVELOPMENT SERVICES RECEIVE® BUILDING&CODE REGULATIONS DIVISION 2300 Virginia Avenue R 2,019 R.Pierce,FL 34982-5652 772-462-1553 Fax 772-462-1578 I.ST. Lucie CoLinty, Permitting APPLICATION FOR TEMPORARY USLPERMIT BUSINESS NAME: 61WQi0- bp Zoe C_ _ NAME OF EVENT: 4c�- 44vK On e LOCATION AND ADDRESS OF TEMPORY USE EVENT: _c2 boo 3 Qr�2R_ F4• Pie-me o= PROPERTY TAX IDENTIFICATION#: s� n- y - 005-0 S© - O(�ar- DESCRIPTION OF TEMPORARY USE: n DATES OF THE EV ENT: APPLICANT'S NAME: _Rworl ``N=w P�GY�e-I-� C'�s •I <.a� � APPLICANT'S STREET ADDRESS: ly93 .5 • �srac. m� CITY: f 1 e_l STATE: Fi' ZIP CODE:,39N4 — WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES V NO WILL THE EVENT HAVE A TENT(s):YES V/"NO (up to 900 square feet exempt from fire permit) WILL THE HAVE BANNERS/PENNANTSIFLAGS?YES /NO V"(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,SECTION 8.02.02J. PRINI APPLICANT NAME jj__GNAybM OF APPIACINT STATE OF FLORIDA,COUNTY OF �•�L-���+P ACKNOWLEDGED BEFORE ME THIS1��-_ DAY OF - _I 20 By V A Olr'1 4!> WHO WHO IS PjktSONAUY KNOWN TO ME), OR WHO HA ODUCED AS IDENTIFICATION. GN OF NOTARY TYPE OR PRINT NAME OF NOTARY NOTARY PUBLIC COMMISSION NUMBER: SLCPDS 10/10/2015 JULMAWAMR Commission#GG 165562 Expires December 5,2021 •�f FO�r MdedTlruTmy Fain Insurance 8&M-7019 PERMISSION FROM OWNER OF PROPERTY DATE: - AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE IV Wr F J c�rnC� TO HOLD A TEMPORARY USE EVENT. PROPERTY TAX IDENTIFICATION#: I 1 Y l (20IED - n 00- -7 LEGAL DESCRIPTION OF PROPERTY: lob 39" ,3-7 SE t .LesS W Van A!W 14 n SE & d-I_eSs G�Z of E Y2- �,s�� c Ess w %df sW '/y.f-CE- PROPERTY E PROPERTY ADDRESS: (�tr1 © e,� 2, �J2n c 1 2... 114 j .F- W joF� E Yq ©.FSE 04 OF S C OWNER INFORMATION: /n� PROPERTY OWNER'S NAME: - l�-1 fX onn i kon cA PROPERTY OWNER'S ADDRESS: .2(t7 00.3. a r4 e_ CrTY: r4- STATE: ZIP CODE: 3V �„ �d�ru �wr-►.sEl� PRINT OWNER'S NAME SIGNATURE OF OWNER STATE OF FLORIDA,COUNTY OF _L uC_� ACKNOWLEDGED BEFORE ME THIS DAY OF �ZO19 , BY F-)n&OL k,ti- t '_f 43 WHO IS PERSONALLY KNOWN TO MEX OR WHO HAS PRODUCED AS IDENTIFICATION GNAOF NOTARY TYPE OR PRINT NAME OF NOTARY NOTARY PUBLIC COMMISSION NUMBER: A? ,i. mmma C mmissionEl% seal res Decembersoa�as.rar9 . SLUM 10!1912415 I P'll i I V 30 ;?"A, a't-'i, -3 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 0812013 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 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. hftp://www.myfloridalicense.com/dbpr/abtidistrict offices/licensing.html r SECTION V °CHECK TRANSACTION°:RE:QUESTED Transaction Type: ® One/Two/Three Da Permit ❑ Special Sales License V SECTION.2 PERMIT or 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) 57-0564993 772 4751158 1 btbea 681 mail.com Full Name of Applicant(s): (This is the name the permit or license will be issued in) Department of State Document# National Wild Turkey Federation, Inc. F03000003125 Business Name(D/B/A) or Name of Event Palmetto Coastal Sportsmen Chapter Spring Banquet Location of Event(Street and Number) 26003 Orange Avenue City County State Zip Code Fort Pierce St. Licie FL 34945 Mailing Address (Street or P.O. Box) 3676 South Brocksmith Road City State Zip Code Fort Pierce I FL 134945 Contact Person -This section isoptional,see application instructions for details Contact Person Telephone Number Bryan Beaty 772 201 5371 ext. Email Address (Optional) btbeaty681 @g mail.com Mailing Address(Street or P.O. Box) 1493 South Brocksmith Road City State Zip Code Fort Pierce FL 34945 Date(s) Permit Desired 4/27/2019 ABT District Office Received Date Stamp Auth: M-5.0013,FAC 1 SECTION 3 SALES TAX h T0.$E.COMPLETED BY THE.,DEPARTMENT OF..REVENUE Full Name of Applicant Organization National Wild Turkey Federation, 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: x SECTION 4. ZONING TO BE CONfPLETED_BY`THEZONING AUTHORITY GOVERNING:THE EVENT:LOCATION Location of Event(Street and Number) 26003 Oran a Avenue City County Fort Pierce St. Licie The location complies with zoning requirements for the temporary sale of alcoholic beverages pursuant to this application for a One/Two/Three Day Permit. Signed Date L—i h Title TIGY) ur., Note: College fraternities and sororities must meet certain additional conditions which can be found in the application instructions and requirements. Auth: 61A-6.0013,FAC 2 SECTION 5` 'DESCRIPTION OF PREMISES TO BE;LICENSED :. AUTHIZED,SIGN ATURE:REQUI ORRED Business Name (D/B/A)or Name of Event Palmetto Coastal Sportsmen Chapter Spring Banquet 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. ParkingEvent Seating l� K' ,Zr Auth: 61A-5.0013,FAC 3 -:� �"_ `_ , SECTION 7 AFFIDAVIT bF APPL{CANT, s _ - ,4 FOR7SPECIAL 3ALES.LICENSE _ Full Name of Applicant Organization National Wild Turkey Federation, Inc. "I, the undersigned individual, or if a corporation for itself, its officers and directors, 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 agree 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 >g APPLIC NT/AUTHORI ED REPRESENTATIVE NAME APPLIC T/AUTHORIZ D REPRESENTATIVE SIGNATURE The foregoing was ( ) Sworn to and Subscribed before me this Day of 201_, By e-o,+ who is (personally known to me (print ame(s) of person making statement) OR ( )who produced as identification. .`ass DOROTHY A.SHAW Vis. .,__ Commission#FF 225519 Commission Expires: June 22,2019 Notary Publ' '' �F' BmdedThuTAYF�n� lG19 Auth: 61A-5.0013,FAC 5 SECTION 6 AFFIDAVIT OF APPLICANT ' ` FOR NON PROFIT CIVEC�ORGANIZATION ALCOHOLIC BEVERAGE PERMIT t }vim Full Name of Applicant Organization National Wild Turkey Federation, Inc. "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 agree 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 and is 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 J I aw&- COUNTY OF APPLfCANT/AUTHOIRIZED REPRESENTATIVE NAME E PLI ANT/AUTHORI ED REPRESENTATIVE SIGNATURE The foregoing was ( ) Sworn to and Subscribed before me this 1. Day of , 20 By By '?)!cy, a q � ;f(1 who is (Vy�e_rsonally known to me (print ndme(s) of person mal ing statement) OR ( )who produced as identification. .,.""""' DOROTHY A.SHAW `' Commission#FF 715519 ,D. V, . J Commission Expires: 201 90,9 Nota Public Auth: 61A-5.0013,FAC 4