HomeMy WebLinkAboutZoning Compliance/Use Permit OFFICE USE ONLY: DATE FILED: I ' " PERNIIT#: wor
Cost: $55.00
PLANNING&DEVELOPMENT SERVICES OREM
BUILDING&CODE REGULATIONS DIVISION
2300 Virginia Avenue JAN 2 3 2020
R.Pierce,FL 34982-5652
772-462-1553 Fax 772-462-1578 ST. Lucie County, Permitting
APPLICATION FOR TEMPORARY USE PERMIT
BUSINESS NAME:
NAME OF EVENT:
LOCATION AND ADD SS OF TEMPOR EVENT:
PROPERTY TAX IDENTIFICATION#:
DESCRIPTION OF TEMPORARY USE:
DATES OF THE EVENT: ULl
APPLICANT'S NAME:
APPLICANT'S STREET ADDRESS: a4VS Rwi
CITY: S�C \ �C'C�� STATE: ZIP CODE:
WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES 4 NO
WILL THE EVENT HAVE A TENT(s):YES X 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 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.
1
PRINT APPLICANT'S NAME SIGNATURE OF APPLiekvK
STATE OF FLORIDA,COUNTY OF SA, U AC'.1`e.
ACKN ED G ECF E _ DAY OF JCI (`- 20 aG. /
By WHO IS PERSONALLY KN WN TOME ,
OR WHO HAS PRODUCED L L AS IDENTIFICATION.
00, ,ftcQyAn Nlz:nn
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
TITLE: NOTARY PUBLIC COMMISSION NUMBER:
SLCPDS 10n9R015 - z
o;PaYP�s�., CARLA NELSON
Notary Public-State of Florida >
Commission#FF 965535
%,;;off �q,• My Comm.Expires Feb 28,2020
PERMISSION FROM OWNER OF PROPERTY
DATE:
AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE/� �ak
1� ^�
TO HOLD A(TTE(MMPPORRARY�USE
EVENT.
PROPERTY TAX IDENTIFICATION#: i �b L
LEGAL DESCRIPTION OF PROPERTY: a2pl
PROPERTY ADDRESS:
OWNER INFORMATION:
PROPERTY OWNER'S NAME:
PROPERTY OWNER'S ADDRESS: �q�ee
CITY: ���► �PS�� �Jtl STATE: J� ZII'CODE: �171
PRINT O R'S NAME IGNATURE OF OWNER
STATE OF FLORIDA,COUNTY OF Z:31 r ie,
ACKNOWLEDGED BEFORE ME THIS � DAY OF -a-n" 00- 202 ,
BY �. WHO IS PERSONALLY KNOWN TO ME
OR WHO HAS PRODUCED L" 1J� AS IDENTIFICATION.
wsa- If
SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY
TITLE: NOTARY PUBLIC COMMISSION NUMBER:
�CARLA NELSON
Notary Public-State of Florida seal
Commission# FF 965535 fY'
',FOFFo.•• My Comm.Expires Feb 28,2020 fa
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SLCPDS 10/19/2015
Special vehicle and boat sales events on sites not approved for the permanent display vehicle and boat
sales may be approved by the Planning&Development Services Director for special public events if the
following standards&requirements are met:
1. Said events shall be conducted on property'having a CG, IL or IH zoning designation, or on property approved by the
Public Works Director for special public events,such as the fairgrounds site;
2. Said events shall be conducted on property having existing, permanent, and permitted driveways and access points.
No new driveways(road cuts)are permitted in conjunction with sales events;
3. The event shall have duration of four(4)or fewer consecutive days and shall be conducted by one(1)or more dealers
having a valid St. Lucie County occupational license;
4. Said events shall be conducted on property having adequate area for vehicle display, employee and customer
parking. Vehicle display areas may be unpaved, However all employee and customer parking areas must be paved. .
Vehicles offered for sale must be displayed only in areas identified as display areas on the scaled drawing submitted as
part of the temporary use permit application. Employee and customer parking must be provided at a rate of one(1)space
per one thousand(1,000)square feet of vehicle display area;
5. Said events may be conducted on-sites approved for other uses (such as banks, shopping centers) provided that the
following conditions are met:
A. No parking spaces designated as being required on the approved site plan for the host site may be used as
display area or customer/employee parking for the special vehicle sales event unless the following criteria
are satisfied:
1. The applicant for the Temporary Use Permit provides a written,certified statement from the
owner or agent for the host site/use that sufficient square footage of approved floor area is
unoccupied to provide parking or display area for the special vehicle sales event;or
2. The applicant for the Temporary Use Permit provides a written,certified statement from the
owner or agent for the host site/use stating that the host use will be closed for the entire.
duration of the special vehicle sales event,including vehicle display times.However;where host uses
such as banks,participate in the sales event that activity will not constitute operation by the host use,
provided that the host use is not open to the general public for business unrelated to the special
sales event.
6. No extension of a temporary use permit for special vehicle sales events maybe granted.
7. All signs to be used in conjunction with the event must conform to the requirements of Section 9.01.02(c) of the St.
Lucie County Land Development Code.A sign permit(s), if required, must be obtained prior to issuance of any temporary
use permit for a sales event.
8.. Sanitary facilities shall be provided in accordance with applicable environmental health regulations. Prior to issuance
of any temporary use permit for a sales event,the applicant must obtain written approval from the St. Lucie County Public
Health Unit for all proposed sanitary facilities.
9. Prior to the issuance of any temporary use permit for a sales event, the applicant must obtain written approval from
the Public Works Director for use of any temporary facilities(such as a tent). Use of any facilities required to be inspected
by St. Lucie County or the St. Lucie County Fire Department shall be inspected by the appropriate department prior to
operation of the facility.
10. Concessions may only be permitted as an accessory use to the sales event. If concessions are proposed, the
applicant for the sales event must obtain written approval from the St. Lucie County Public Health Unit for the proposed
concession facilities,prior to the issuance of any temporary use permit for the sales event.
11. Special Vehicle Sales Event applications must meet all submittal requirements for a temporary use permit
application. In addition,special vehicle sales event applications must include the following:
(a) A scaled drawing showing:
1. The dimensions of the property parcel upon which the event is to be held;
2. The dimensions of the sales event area;
3. Location and dimension of all display areas,parking areas,and driving aisles to be utilized;
4. All adjacent roadways and driveways of the property parcel site;
5. All signs to be used in conjunction with the sales event and the size and type of sign(s)
used;
6. Existing zoning of the subject property and applicable setbacks.
(b) Information identifying:
1. Beginning and ending dates of the event;
2. Hours of operation of the event;
3. Approximate number of vehicles displayed at any one time on the event sited;
4. Any temporary facilities,including sanitary;display(such as tents),and concessions;
5. How parking and traffic flow will be properly directed onto and within the event site;
6. If existing parking spaces of a permanent use(such as shopping plaza)are to be utilized by
patrons and employees of the sales event, calculations shall be submitted demonstrating
that the sales event will not utilize any parking spaces necessary,in accordance with the
parking standards specified in this Code,to service the existing uses.
�y AW, w_
J. Special vehicle, recreational-vehteldt rttoto icW_fi goat sales events on sites not approved
for the-permanent dt5play of or fo_r vehice aid, ssa��!s may be approved by the Planrimk and ,z
tTevelonrirent 9e�vrceS,Director or his:.vr h'e��est�iree�' �ft�4e�
3
fvfrowrng f0diremer t ands#andai�ds are m t 4 }
2. Said events shall be conducted ort py!laving a CG, IL or IH zanin desi nation- ~
Y g g fM
�t -
vA�f�.-ru1+�+-w�•'FMe-�s:rn•nonFlee+� - ,_� _t- -._.. .
tip
OR
2. said events shall be conducted bFprclpert�y havtng;existing, permanent,-and permitteit; r
driveways an�f access points dio nevi�drivevvays (load cuts) are perrmitted
s..
conjunction-With sales events,
-�J 3. The even# hat! have.a duration of hr`ee S let }or fewer consecutive.dajrs T
"three�`bt ddVs:includ&set do and 6�eal<down ofthi5 event an f shalt be conducted Uy"
one or more deaters.havmg a valid tttece; thirty bu5ne5s tailtei -license'
i
-•.3 c 4
lVo more>than`fwa(215a1es a rents s(i fl he ca iducteo on the same oroOON d0-ina anv
catencar year'`
4: Said events shall be conducted on property flag adequate area for vehicle and vessel
display` employee and customercrrYg
eK,tev$`r;al#Aft disbtay employee aad', fe rq a.perking areas must be-paved 1.1 i i sz
and vessels offered fdt sale must' c rn areas rdentifiect as display
n. e.the`scaled dra+luing sutrit#ed a pairL of themporaryitse Kermit appttcatior
w
Employee aqd,custonier OrWed at a rate of:one space per one
- s
A th -01 hd LL-000) sop to feet' isp"Ia� area. The site must.have:aarkin lir
exeeas of the r'eaurred:'narttin r
K.
o Atli htt5� i#e`
.5. The event shall not use a4 ifiee iercertt.(15 %):ofrthe;ekcess.oarlune for-thc
site fort dspta o nesse ar i�ehtcts trade m vel►icle and-emplaie aril
` t
east mEie . 'ar 'n { ' fe:ifs erred to "ravide 25T3 #6 "iflcin ares:
and has. 5 av d: c �thexe are 3 excess arkr s res iFift n; icer
or` 5 sicest
of INssatsarCinemy€bdt+lized for tke teiryiporary sates eves
No other parkins sdac ' Cieu" erf for ee►yiurnose-releted to #tie ferrinorary' Sales
event = `:
r
ti. Said evpnt5 i71ay be tfo�at offs ttei apprc3Yed'forother uses(such as banks,shoppir
cents_isj provided thslitkiefoltavvrng caniiiE)ons airermet:
(aj
No parkingecesrgnatad a3 lip<ing required on the,approved site plan for r
1
• the host sl��,`�.t»i�y 4 Be. used >;a�`�d�sp:.la�c area,. trade-in nam� tsr �` _
custamerjetn [aea Barking the}special::vehicle sales event Mess- e
L :. a
WW -
- nom: :,• '' �^�=' ti�k. '.. .-„
} passages are deleted. Underifrted passages,ara added.
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Y-" •7 yF3.. rL �• fa' ,r;a rk.fcu"'k .-` n.3' F, x
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(b) No actry ' tem ora t7en>` rte 616.; terry ora san a facet ��
- - �associete �w t e `ventre a`1F� oser'` #iarr five:hun�#r`-d: Son feet��f�biri�"`"` ;�,
_ nvatePst a :lr e r4i, Nto t- f ttr u Bred 3Cir1 t frairt an .' rztat %'-�
eiwn�d prof ice air #t1trifd tai�itncts e
_ r
7. Na tadnsion7of a tempssrary tisse pertictit arspeerel Vehicle and/or�riessels sales everts
rt t
�-
may-be:Mote. � Y
1 8:
All srgns,ta be user{ri�eoirtunction w�th�the e>� rid must confam�ltothe re uirements of a
r
Sectiatf 9 ff3 0 {
4
v cje St Lucie GoUnty{ teuetaprhentocte A sign perEnit(s)t itf
rqutr'cd muist`be abtarnad p'Ctor tg:i5suartce a any temporary. use permora
it fsates
Event. i
9. anttary facrlitles shalt%provided rte°accotd4.fit Ith a00110ble_environmental#fealtt
�, .
r�eguCatlgns Prfiar s+ st�anc any'teto�re�ry use permrt forkaies event,#h
appli�nt must optain rrttQ IPA. GA ` heSt I�ucTe County t*ubltc Heaittf U�iit for
'vC'S`.c F
atCpropcFsecisar�it�ICaCitiUesli�ariitartracrti�eshat#.Eieremo�ertitirnTedrat�l�atth
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esti{af�a scot sa#e even h, -
t w
"nm
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10. Pryor to the rs5ua- I t fany tempolca" u$e i" for a sates eveet,the ap lrcah 'must
r
okrtain wrtttan at ►'os # frim t�t �ontl #3eye#otiutentr�SErvices t3rtecto3=
�tsMo �rtr�temarary#acrtitles {suclf as-aentl
Use ofIMIM k141.
any facilities rtea�iseeni# iarved bySt.luae Cautfty
y ,
prior Zo d3ratic fifths fatitct3 _
11. Concessions may ottl`1 b ierr pitted"as It�accessa ry use to the sates event t
� 5,,.E + tn-
concessions are pr„oF�d €he�a�Yp�rC�#c>tifcr" ie sates;event=must :obtain► wntten
appratiat from the zea entci r fear#hey
propose COnee5510fa 1 pTi01,t1 i 5i;i iuf any'ter�rpora use`permit for the s
sates went. v
12. Spedal Vehicte� an ss21 Safes rrt 3ert a cations crust :nrieet all,subt«eittaf
.qu s r,t tYl p t � tion inti additions; spec#al v saC
re rr�trrersts Erntel use et' il<
event apptieations`lirest iiruste the:fotloar ;
f _
- gk passages are deleted: erilne Und
__ , a passages aTe�ddec� .
-{ -- -
(a) A scaled diiWirtgshowing
1. The cimensians tite property parcel upon which the event:!s to be
T:. .. ..
2. The tlinen5ions of the sales evenf area:
3 t.ot�tion and.drrnens+ n�of display, areas, errmpioyee and customer -
r _ patkrng areas,and df+Virg arsies tb'tie utilied.
i
A. Alf',ad�acen#roadways and tirtveways`of the proper.Ey parcel site.
S. Al!s+ cis to ` p
y7 ysed in caniuncttct with the sates event and the s+ze and
`
type +Exs+ n(s} used AErrYE 19recruired for al( temporary#fiaes�
- - baniiers'a rd i�ennants.. '= n - -
pg
6: Ex+st+ng3zon+ng' af.the su jetzt property, surrbundme,dretpert+es and
appl+gable setbacks;
7. The st ted :dray ine-shall.i fentii .the:foiiouvrn rises and thd�reE#u1i
= setbas mil aetryrtyL temoaar tent mleefianrcat dey+ee feainporai
` sariawfacil�tu assrrciated viniki< event must b setback a least +v8
hiinirSd01e�t fraraitjidentially zoned 06t,two hundred $f?}
feet# + < ;fscf6hc otr orrvatee #l+ne and three hundred t3 � feet
franv_�riya#elv owned t�eoperj'+rrariculturai:and rural d+striets :
(b) lnformat+on+dn�rymg.
s
1. Begrnt+ng antlendIng'datestafthe'event. :
2. Hourofopeat+on of the event
3. Total t to e=number°of veb cI s andlc r vessels_displayed at anti
r one#nine ah the:evert site .
A -�
c fcuiatron shall be Prov+ded that dernoristrates the went does
s `o e=than ttn a: edt:'15 46 of:the excess:"axk n for
t e� ;#� �1~� elides and ar V sets t` de+n v +cle
e o eti ax omtf Pekin tem tent wash
:'
- .rece�tdicles cctrtceafions atit��mrx3"rary sari�aty.faciiit+es.= :
t3 7E e' ` ent haft kr ' bandiea par aces w+th to oNN
ra
.S a 1iaCPAr nC i;
i rf�eiiCa I I���a_brit pct anis:�t dht'°
i ra
4: Any empurary feaiities, rtcf4010 sanitary, display:(such as tens},
The�s„e,,,,faciGt�es m�u' renuir�
• ar �r`�i���`>•c`om othier�eu,�ei�s`and a�encres. -
lb passages are deleted... a rlin'd passages are addert
01.
5. lav ming°and trays flay v'vvi#i'be properly directed onto;a4dWithiFY�
a dy Ah ebent site l
i`s t eir 0 parking spaces i a� ncmeinent use {such as shuppi#M> e `
v Ef
utilized 6y patccm5 ark fnplayees of the sales events a k
alis ►'
1 2
ca cttl ri�rlsfor t ie site snail O bffiltt d demQnstrati►ig that" s ie
ti_ t
.. evert.vwlt,;nat trtr lie,any ire �j►ired par.. 9S,;spaces "Cess aDy, Vin` 3
accar66ce with this:patkirg staar specified�n t _
tis h15 code -tt1 serVlE«E~
3+
the eutsting
use
A the faltowna shall be rrovided�',
-s--r—
The site's toad nwmbet�oi tsartanA spaces.
The tatalc[uinbe �fnr soaces retuired for site estEnt"- �
R21
r
�SermRtfeii useincwIth ttie t�arklr staiicfa+cfissnec�r
y
ifict i g n
.� the number`:bf a ess tnat rectuired) darkine spaces muttmued >F -
13. 1 t► a iicarlth 1 `provide a rtttert n�Wrirbtttoriaation f spm the toe a
v
statrA :the €� oe�tt ra rs a tl at the tocat#arw-.0 iriciude datei+au
ofoperatiafi artd ti vet afif e` siva a ti h nurrihers
p_f14 -The Ptannin, a � irelopttieitt Seryfeir may susa�r�A.
d considerattan oa
x ^» uk f s
MW
:al�cat#anEt
raeee �irciiii i dill}r f hey wed Whig` a ttealei'" k
4' d'¢yi'F`h:! ms's ��
h s been ct t ce tt�
MKS to S i e stl�a� non�tr�i ha��of
'a- ';�.-�• �.,1'' `' yK�n""@S��'`}�z''1'Lr-zsi
sategeet►t a s. een,it�uad ncts a46N I doral rtes e� E r x
o hest!fob art > tE>p o all not be carisidere ftp r ' 'ritr ,x
��`_ taNO %,yrs at'��date o€t�ir�ta't�fbh fi `:
25 Th rers !)w nm,avernight c4 itirt tt e s Bela sates eu at <
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" a c{alsales haiF vide�uaste� cfes:a, are trot errnitt fo tese#�
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' w" -hast�artrper -shim
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R'3
PARI; calm PVt
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Special arts of the Fforli a ieg�slatt re Al&t}bl 0"VA s fated areas of St.Lucie muff
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orziirtanceon,dCotinty.resatutiostis#hereo tcFvgttiithis ordinarice are heretnt
sper5ei#ed by this.tsrdnance to the E3 ? sueh taictct -
..
R1RT Sci?�Et3tEti Y.
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if atiy pertian txfthis+p7;7.tdinance is ftlasari held gr€tld to.be unconstiutional, noperatrve,or =
oli� S C fipl fig s.sell nvt ar ctsl, ,�T�t'�lOiniRg,F10 !"qfCllridfiC�. ff this,ordinaRn
n ora t.
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t unc[4l e i passage .are added
ale deleted. _
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ZSf�YR�WtflGLr arlAi �Nl�t �WR .C ��RiVN k - e ` 4
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Cont►�etcxcfe's l�taddal,5 Festiva{ ddtes' 7
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`City Pens sea(h Mate FL cp 34J57
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Ravin j,trade appktatiot�n due,form,and as the cotidit�drts,srrrotutdng,aril arranements ►iry opinion suctt#taCt#ea nrothe"r`,.'
came cin E a abserve , uthor rs here#y givers end the P>:RiY4t l-is l'itiatlteEl he instaliown tom_ ' -
F Yom. - .e
,Teach6r1xt20 ent,f§!�fq�gFest-,,i Set-,U-a -Mar`ch.1$&'€eardownnit;March24;2t32U _-t'ft()•SIUt£NStitilG'lNTfN'Fy
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_IPl1?rotect Name: le Island Spri�11-ng Festival I'lA#rlress 8€l1 S.C?cean t�►ve
Cit Jensen Beach -State ft zi '°3, , i --
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This permit noes not"take t{a piace6,of any license r+eciuired by lava and is nqt transfefable:'Any cfiati6en'the use,O,r occupancy of the -
prem�ses shalt require a new permit. -
Days Valid - Contractor' sf , pike Marshal Paul Langel � �
a
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h1:1HtS PRMITSHAi.t.AT AL-L T11V�E 6ECR' POS'C> D 0��11H�PiEMIStESrj'.t�1STEt�ABdVE r:
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�-`'L�i •w�'h'�' 1^ y..Y)'h ,.s{ '�#:g fy.;.0 ' 3. ` !+ =- I
Business Name(D/ , ~ ^
Neatly draw a floor pian of the p es in tin ,including sidewalks and othe outside area which are contiguous to the premises,
walls,doors,counters,sales areas,storage areas,restrooms,bar logtions and any o 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.
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Auth.61A-5.0017 4
Auth: 61A-5.0013,FAC 3
DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
Temporary Permit ❑ Special Sales License
Full Name of Applicant(s)
The permit will be issued in the name of the applicant as.provided on the application.
S M u
Applicant Mailing Address
City County State Zip-Code
WS7Applicant Telephone'Number Applicant E-mail Address
`Z 7a- _
Corporation or Other Legal Entity
If the applicant is a corporation or other legal entity,enter the name and the document number related tolegal entity as
registered with the Florida Department of State Division of tions.
FEIN Number Florida Department of State Document Number
I gin.
A contact person must be designated below if the applicant prefers to designate a person other than the applicant to receive and
reply to Division communications regarding this application. The designated contactperson wi11 be pennitled to make changes to
the applicationpaperwork on behalf of the applicant,and the Division will communicate directly with the contact person regarding
the application. The applicant will not be copied on communications from the Division to the designated contact It is the
responsibility of the applicant to inform the Division if there Is a change of designated contact and/or to the contact information of the
des/ nated contact-
Full Name of Designated Contact
Designated Contact Mailing Address
City County p State Zip Code
c C S4 - CA FL "l
D 'gnated Contact E-mail Address Designated Contact Telephone Number
Ems.
RECEIVED
JAN 2 9 2020E "NC)PY
FIL
ST. Lucie County, Permitting
INCORPORATED BY REFERENCE.61A-5.0013,F.A.C. EFFECTIVE 912019
DBPR ABT-6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
Dates of Active Use for Temporary Permit or Special Sales License
Provide the dates of the event or sale when the permit or license will be effective. The dates orovided may not exceed three da
Day 1 Day 2 Day 3
Ad ess for Physical ocatlon of Temporary Event o Spectal'Sales Event
C)Cenu DO
City County State Zip Code
l.t v�• FL -t
Is the event location currently licensed for sales of alcoholic beverages under a perms ent
license issued by the Division? Yes® No®If rs.obtain attestation of permanent license holder in Section S.
ME
Full Name of Applicant(s)
Florida Department of Revenue Verification of Registration
The named applicant(s)for a temporary permit or special sales licerl ,{ rt� h' with Florida
Statutes concerning registration for Sales and Use Tax and has paid ofgt any applicable
taxes due.
Authorized Agency Signatu e °` Ul
6
Printed Name
S,
Title —_� eCt c• s� ___L_ RECEIVED
Date O a3 a Ir-
JAN 2 3 2020
FORT PIERCE SERVICE CENTER
INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 912019
DBPR ABT-6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
Location of Temporary Event
Street Address �01-1-1
k � , ���� ��`��
city n� County State Zip Code
zt�e� � � 1 �1 FL
Local Zoning Approval
The location of the temporary event complies with local ordinances for the temporary sale of alcoholic
beverages based_on the information supplied by the applicant in this application.
Authorized Agency Signature
Printed Name
TitleVe
(
Date
INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE $12019
DBPR AST—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
t
Full Name of Applicant(s)
oej'W�s �' (Ah
Name or Title of Temporary Event
Neatly draw a floor plan of the premises in ink,including:sidewalks and other outside which are contiguous to the premises,
wails,doors,counters,points of sale of alcoholic beverages,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.
GO x
l
i
Mt� 1 i
INCORPORATED BY REFERENCE:61A.5.0013,F.A.C. EFFECTIVE 912019
DBPR ABT-6003 APPLICATION,FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
• �Ntri' _
Full Name of Applicant's
��-eAes
`The applicant requesting the permit in the above and foregoing application is a nonprofit civic organization,charitable organization,
municipality or county,and the permit,if used,will be used only by the applicant organization on the date(s)requested and at the
location stated.By acceptance of this permit,the applicant agrees that,as a nonprofit or civic organization,all net profits from sales
of alcoholic beverages during the permitted period will be retained by it,or,as a municipality or county,all net profits from sales of
alcoholic beverages during the permit period will be donated to a nonprofit civic or charitable organization within 90 days after the
permitted event. As a municipality or county,the applicant attempted to solicit a qualified nonprofit civic or charitable organization to
conduct such sales for the permitted event but has been unable to find such a qualifying nonprofit civic or charitable organization in a
reasonable and practicable manner and timeframe.The applicant organization has not received more than twelve(12)permits within
the calendar year,unless otherwise authorized by law;and the applicant agrees 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.Deputies,and Police Officers for purposes of
determining compliance with the Florida Beverage Lavir.
1,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 and,as such,I swear under oath or affirmation under penalty of pedury as provided for in
sections 559.791,562.45,and 837.06,Florida Statutes,that the Ing information Is true and correct."
C
at of Applicant/Affiant
STATE OF l�1 C
COUNTY OF - ,IC Ate
Sworn to(or affirmed)and subscribed before me this D day of "1 00,1- ,20 U
. T—
by (print affiant name).
Personally Known
Produced Identification
Type of Identification Produced
--, Signature of Notary Public—State of Florida
CARLA NELSON
Notary Public-State of Florida
N9
W Commission#FF 965535
My Comm.Expires Feb 28,2020
Name of Notary Public—Typed,Printed,or Stamped
(NOTARY SEAL) Commission Expires:
DATE ACCEPTED BY DISTRICT OFFICE:
INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 912019
DSPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
Full Name of Applicant(sl
"As the applicant requesting the special sales license in the above and foregoing application,I understand that this license allows
package sales in sealed containers for a period of up to three days,and does not permit the sale of alcoholic beverages for
consumption on the premises.I 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,Deputies,and Police Officers for purposes of determining compliance with the Florida Beverage Law.
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 and,as such,I swear under oath or affirmation under penalty of pequry as provided for in
sections 559.791,562.45,and 837.06,Florida Statutes,that the fo oing information is true and correct."
ature of ApplicaiWAffiant
STATE OF
COUNTY OF �
Sworn to(or affirmed)and subscribed before me this c2O day of 3Wrl JO-' 20
by u� v . (print affiant name).
Personally Known
Produced Identification
Type of Identification Produced
o�"��P�e�•, CARLA NELSON Signature of Notary Public—State of Florida
? c Notary Public-State of Florida
?�9
Q Commission#FF 965535 Mf
My Comm.Expires Feb 28,2020 � rl l 6c) n
Name of Notary Public—Typed, Printed,or Stamped
(NOTARY SEAL) Commission Expires: �c7
c
DATE ACCEPTED BY DISTRICT OFFICE:
INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 912019
DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE
s
An attestation is to be obtained from the current,permanent alcoholic beverage Home holder when the temporary event of the
applicant nonprofit civic organization,charitable organization,municipality,or county is hosted at a location that is permanently
licensed by the Division of Alcoholic Beverages&Tobacco for the sale of alcoholic beverages.
NOTE:The 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 nonprofit civic organization,charitable organization,municipality,or county as part
of the application for the Temporary Permit.
Full Name of Permanent License Holder at Temporary Event Location
Business Name(D/B/A)
License Number Series of Permanent License
Series Type:
0,
Contact Person for Permanent License Holder Contact Person Telephone Number
Ext.
Contact Person E-mail Address
Name of Applicant for Temporary Pennit
S
YES
Date(s)of Temporary Event
Day 1 Day 2 Day 3
UaTh af 1-\e)
rh
A temporary permit i ing requested for an event to be h6ld on your licensed premises. During the
permitted dates and times of the event,no sales or service of alcoholic beverages may be made under
your permanent alcoholic beverage license in the area identified for use by the temporary permit applicant
in Section 5 of this application. Failure to comply may result in administrative charges being filed against
your license.
DateaO
Signature of armament License Holder at Temporary Event Location .
Printed Name of Permanent License Holder at Temporary Event Location
INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 912019
DBPR ABT-6029 Division of Alcoholic Beverages and Tobacco
Application for Extension or Amended Sketch of Licensed Premises
STATE OF FLORIDA DBPR Form
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT4029
Revised 0212013
If you have any questions or need assistance in completing this application,please contact the Division of
Alcoholic Beverages&Tobacco's(AB&n local dkNct offibe P/ease-submit your completed application
"and required fee(s)to your local disbfct office This application may be submilfed by mail,through -
appointment,or it can be dropped off A Disbict Office Address and Contact Infonnatron Sheet can be
found on AB&rs web site at the link provided below:
httg-)://www.mvflorida.com/dbpr/abtfdistiict offices/licensing html
nPerymanent
Type:
ry F�ctensionAmended Sketch
Extension
Lice (as ' on al tic bev geM
nse
1
Busin Name(D/B/A)
Location Address(Street)en
`
Cay C��- �,, FtLate Zi r .
Alcoholi eve a Licena Nu Series i Type/Class
Business Tele h Nu ber 1 ail d ( ti I
ext. ( -
MTEMPORARY F, T�NS/ONS ONLY.-
Date(s)of Extension:
RECEIVED
JAN 2 3 2020
ST. Lucie County, Permitting ABT District'Office Received/Date Stamp
COPYS ..
Auft 61A-5.0017 1
Location Street Address
CityAelmen
,County 1J Zip-!!2 Co
FL
Are there outside areas which are contiguous to the premises which are to be part of the premises sought
to be licensed?° [TYes ❑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.
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.
i
a �t�- Titie� �ZG�'1 nE' Date: —0 3
Signed: -
VtSuY
This approval is valid until
The above establishment complies with the requirements of the Florida Sanitary Code.
Signed Date
Title
Agency.
This approval is valid until
Auth.61"0017 2
Business Name(D/B/A)
01,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 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 a
op'wo for a temporary extension,check the box to confirm the following statement:
Ed "9 understand that the premises must be restored to its original foam at the conclusion of the
authorized temporary,event."
STATE OF
COUNTY OF
APPLICANT SIGNATURE
APPLICANT SIGNATURE
The foregoing was( )Sworn to and Subscribed OR( )Acknowledged Before me this, Day
ofd �4 20 , By Q who is(personally
(print names of person(s)making statement)
known to me OR( )who produced �- - as identification.
Ows&-- Commission Expires: l a 8 a-O.
Notary Public
1
l•
\\\111111/, - -
;,►�YP/B CARLA NELSON
` MCC, Commission#FF 965535� My Comm.Expires Feb 28,2020
Auth.61A-50017 3
Business Name(D/B/A)
Oe,(
OV
1. Yes ❑ No O I is the proposed premises movable or able to be moved?
2. Yes ❑ No o Is there any access through the premises to any area over which you do not
have dominion and control!
3. Yes ❑ No k 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:
❑ 56120(2)(b)l,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 when:the entire building is to be licensed must show
the details of each floor.
lU ►
CAUb
Auft 61A-5.0017 4