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HomeMy WebLinkAboutZoning Compliance/Use Permit [dMCgUSEONLY; DATE FELED: PERMIT N. s- Cosh $55.00 PLANNING&DEVELOPMENT SERVICES BUILDING&CODE REGULATIONS DIVISION 2300 Virginia Avenue R.Pierce;FL 34982-5652 i 772-462-1553 Fax 772-462-1578 APPLICATION FOR TEMPORARY USE PERMIT _L BUSINESS NAME: NAME OF EVENT: A jJ—\ LOCATION AND ADDRESS OF TEMPORY USE'EVENT: �} PROPERTY TAX IDENTIFICATION#: .� _ CvjC'z as SY3 DESCRIPTION OF TEMPORARY USE:. rAN %,_e r ,i!j \iz�,k l c3 htT ,Jay it S DATES OF THE EVENT: 0k APPLICANT'S NAME: APPLICANT'S STREET ADDRESS: CITY: .Q t cA STATE: - ZIP CODE: cL1R, i WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES�O NO WILL THE EVENT HAVE A TENT(s):YES >4 NO (up to 900 square feet exempt from fire permit) WILL THE HAVE BANNERS/PENNANTS/FLAGS?YES "24 /NO (Only I 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. PRINT APPLICANT'S NAME SI TURE OF APPLICANT' STATE OF FLORIDA,COUNTY OF � ACKNOWLEDGED BEFORE ME THIS r, DAY OF 203, By WHO IS PERSONALLY KNOWN TOME OR—VMO HAS RODUCED AS IDENTIFICATION. (L-SPi5A=JOTAle�' TYPE OR PRINT NAME F NOTARY TITLEY PUBLIC COMMISSION NUMBER: SLCPDS 10/19/2015 :fir"vue:; ROBIN Joy DRUMS : Notary Public•State of Florida Commission#GG 217741 My Comm.Expires Sep 11,2022 Bonded through National Notary Assn. PERMISSION PROM OWNER OF PROPERTY DATE: .. `I'.�1�,. Zo AS OWNER OF THE FOLLOWING DESCRIDED PROPERTY,I AUTHORM lD HOLD A TEMPORARY USE EVENT. PROPERTY TAX IDENTIFICATION M. 2- LEGAL DESCRIPTION OF PROPERTY: k� �_2 T- 3 S 2 3 PROPERTY ADDRESS: ®(� 3 ©.• e try-�.ti u f �. �,Gu OWNER INFORMATION: M �PROPERTY OWNER'S NAME: ct W5 ,C4 a nG . PROPERTY.owNEws ADDRESS. _.ZU100 3 . . CITY. I-�7�• t'LC� STATE:._CL� ZIP CODE;_ 7 - , PRINT OWNER'S NAME SIGNATURE OF OWNER STATE OF FLORIDA,COUNTY OF,8L 'WYCI 2 ACKNOWLEDGED BEFORE ME THIS DAY OF BY A/ 1Q F L. L• Mc d WHO IS P`ERSOMLLYXNOWNTOMI&j�- 0 WHO IIAS PROD -AS IDMWMCATION. • 1 e�r�nG �n�v�L�ncLs SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY TITLE;NOTARY PUBLIC COMI4IiSSIUN'MJltiii;ER: - I ; i3St DEONNAEMMONDS , t MY COMMMION#GG 367004 'M o= EXPIRES:NovenUr 2,2023 • SLCPDS IQd9tdal5 I N `V Receipt COUNTY Online address:http://www.stlucieco.org/planning/permitting.htm * , Quick Links: Permit Status Lookup Planning&Development Services Online Building Inspection System Building&Code Regulation Division Daily Inspector Schedule 2300 Virginia Avenue Fort Pierce,FL 34982 Phone:(772)462-1553 Fax:(772)462-1578 i Date: September 15, 2020 Receipt M 0000167135 Permit Number: 2009-0333 Job Address: 26003 ORANGE AVE Amount: $55.83 Paid With: VISA Credit Card# 6287 Paid By: JULIA BUSCH Received By: ingraml Fee Description Fee Amount NBIMS651 N-BP BIMS $5'.00 NZonin1036 N-Special event-Temporary Use $50.00 Credi15 06-Credit Card Fee- 1.5% $0.83 Total: $55.83 9/15/2020 12:55:51 PM •✓' ,; ' OFFICE USE ONLY: DATE FII.ED• — -----_.—_—_—pERNIIT#: Cost: $55.00 PLANNING&DEVELOPMENT SERVICES -11 BUILDING&CODE REGULATIONS DIVISION 2300 Virginia Avenue Ft.Pierce,FL 34982-5652 772-462-1553 Fax 772-462-1578 APPLICATION FOR TEMPORARY USE PERMIT BUSINESS NAME: VAS C v ,\ �buti- I vll� Sc� NAME OF EVENT: �tJ`i\ l�'G%y-e. LOCATION AND ADDRESS OF TEMPORY USE EVENT: -Z3 b'r�t�o t��1��_ y ILJ PROPERTY TAX IDENTIFICATION#: - pc a5 �x.3 DESCRIPTION-OF TEMPORARY USE: -12 4- �,b"\o k l O �s�Z_h G.h nn S I - DATES OF THE EVENT: \ C� �. APPLICANT'S NAME: APPLICANT'S STREET ADDRESS: S3,cU SA ' CITY: STATE: — ZIP CODE, of WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES OX NO . I 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 (Only 1 per 3001inear 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. PRINT APPLICANT'S NAME SI TURE OF APPLICANT STATE OF FLORIDA,COUNTY OF ��� ACKNOWLEDGED BEFORE ME THIS DAY OF By WHO IS PERSONALLY KNOWN TOME OR O HAS RODUCED AS IDENTIFICATION. cA. I IA. ,a,� J,w. pl�yu�n`J OTA - TYPE OR PRINT NAM OAF NOTARY TITLE: NO ARY PUBLIC- COMMISSION NUMBER: SLCPDS 10119IE015 ter Po ROBIN J:GG Notary Public Florida Commission747U" My Comm.Exp1,2022Bonded through Natry Assn. PERMISSION FROM OWN=OF PROPERTY t DAM `I !/ l ZD Zo AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE TO HOLD A TEMPORARY USE EVENT. PROPERTY TAX IDENTIFICATION M. a l L -- 3 // - o o v / a d v _ 2 - LEGAL DESCRIPTION OF PROPERTY: - 2, % 3 5- PROPERTYADDRESS• 00 ®✓`"fie lh u-t , t 'f• �i��c.c OWNER INFORMATION: PROPERTY OWNER'S NAM: PROPERTY��OWNER'S A_ DDRESS: 2 00 3 CITY: STATE: ZIP CODE: 1 Ak4'ram.S �lvl.�• PRINT OWNER'S NAME SIGNATURE OF OWNER STATE OF FLORIDA,COUNTY OF—,%, Lucie e ACKNOWLEDGED BEFORE ME THIS DAY OF - BY AA I CbQ P L L• !`l40 WHOISPERSOMMYKNOWNTOME O WHO HAS PROD AS IDENTIFICATION 2Ofl 60 TM 0r*d-s SIGNATURE OF NOTARY TYPE ORPRINTNAME OFNOTARY TTIM.-NOTARY PUBLIC COMMISSION MUM- I I '02 -7-OZ15 DEONNAEMMONDS W COMMISSION S Gfd 367Q09 seal :.• ;.__ ='a• •o EXPIRES:November2,2023 • SLCFBS IUl19niBiS 4 FORMS DBP` ABT 6D0� APPLICATION FORTE . PORARY RMIv t OR SP CIALSALES LICENSE f DNISI_ONOF AL�,.1 Q.;_OLIC BEUEIGEStANDT06'AC;CO,; FORM DBPR ABT—6003 IS REQUIRED TO: •Apply for a temporary permit, not exceeding three days,to sell alcoholic beverages for consumption on premises only; or •Apply for a special sales license, not exceeding three days,for the package sale only of alcoholic beverages. '. ; NX FORM DBPRAB�T6003GHECKLIST � "' '' a TRANSAGTI�N° s x � SAP;LICE�TIO[�,=REC��IREMENTf- 51 1, OR, _ 0 APPLICATION FORM DBPR ABT—6003 ❑ Complete Sections 1-6. ❑ Obtain Notarization for Applicant Affidavit in Section 6. ❑ Determine if Section 8 applies to the location of the event and obtain attestation of permanent licensee if applicable. 0 APPROVALS BY OTHER STATE OR LOCAL AGENCIES ❑ Section 3-Sales Tax Certification Obtain approval from the local area office of the Florida Department of Revenue. TEMPORARY PERMIT ❑ Section 4—Zoning Approval Obtain approval from the city or county zoning authority governing the location of the event. 13 APPLICATION FEE ❑ $25.00 Payable To: Div. of Alcoholic Beverages and Tobacco 0 FILE APPLICATION FORM DBPR ABT -6003 ❑ Submit the original, completed application with the required approvals and the application fee at least seven (7)days prior to the first date of the planned event. 0 APPLICATION FORM DBPR ABT—6003 ❑ Complete Sections 1-3 and 7. ❑ Obtain Notarization for Applicant Affidavit in Section 7. 13 APPROVALS BY OTHER STATE OR LOCAL AGENCIES ❑ Section 3-Sales Tax Certification Obtain approval from the local area office of the Florida SPECIAL SALES LICENSE Department of Revenue. • APPLICATION FEE ❑ $25.00 Payable To: Div. of Alcoholic Beverages and Tobacco 0 FILE APPLICATION FORM DBPR ABT -6003 Submit the original, completed application with the required approvals and the application fee at least seven (7)days prior to the first date of the planned event. INCORPORATED BY REFERENCE:61A-5.0013, F.A.C. 0�bp EFFECTIVE 912019 l DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE SECTION'8: AT�TESTA=T�1014 13 ry WRMANENT LICENSE HOLDER . FOR=`USE�OF L.ICENSEDPREMISE3-AS ' PERMITTED'LEMPORAfY EVENT . An attestation is to be obtained from the current,permanent alcoholic beverage license 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: 'Contact Person for Permanent License Holder Contact Person Telephone Number Ext. Contact Person E-mail Address Name of Applicant for Temporary Permit Date(s) of Temporary Event Day 1 Day 2 Day 3 A temporary permit is being requested for an event to be held 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. Date Signature of Permanent 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 9/2019 DBPR ABT—6003 APPLICATION'FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE Ate# CONA INS UCT NSFORa�1;E0 $' It,, PEL"CATIO " SECT[O• S SECTION ADDITIONAL INSTRUCTIONS Registration of Legal Entity or Proof of Nonprofit Status All corporations, domestic or foreign, and limited.liability companies seeking a.permit are required to be registered with the Florida Secretary.of State, Division of : Section 1: Corporations, as an'active nonprofit. Organizations which are not incorporated must Applicant . submit one of the following: a letter outlining the purpose and the goals of the event and who will benefit.from the event's profits;the organization's national, state, or local Information charter;the organization's by-laws, 501(c)3 registration, or minutes of meeting.. The application will be considered incomplete without this active registration and proof,of nonprofit status. For further information, contact the Department of State at(850)488- 9000 or www.sunbiz.org. Sales Tax Certification Section 3 must be completed by the Florida Department of Revenue confirming that the Section 3: applicant has complied with the Florida Statutes concerning registration for Sales and Sales Tax Use Tax and has agreed to pay any applicable taxes due. Applications must be Certification submitted within 90 days of DOR approval. The address and other contact information for Department of Revenue area offices can be found at: http://dor.myflorida.com/dor/taxes/servicecenters.htmi. Local Zoning Approval Section 4 applies only to applications for a temporary permit, not exceeding three days, Section 4: to sell alcoholic beverages for consumption on premises only. The city or county Local Zoning zoning authority serving the area where the event or special sale will be held must Approval complete this section confirming zoning approval. Applications must be submitted. within:180"days of receiving zoning'approval. The'address and other contact information for area zoning offices can be found at: http://www.myfloridalicense.com/DBPR/alcoholic-beverages-and-tobacco/. Description Of Premises of Temporary Event(Premises Sketch) - Section 5 requires a complete sketch of the premises, drawn in ink or computer generated (letter size), detailing all permanent walls, doors,windows, counters, and labeling each room and area. Any outside areas where alcoholic beverages will be Section 5: sold, consumed, or served must also be included in the sketch. Due to the difficulty of Description Of scanning, no blueprints will be accepted.' Premises of When the event will be held at a location currently licensed for the sale of alcoholic Temporary beverages, a sketch of the entire premises must be submitted. If the event will not Event make use of the entire licensed premises,the sketch must identify the separate room or enclosure area of the licensed premises where the event will be held. In such circumstances,the attestation in Section 8 of this application must be signed by the current, permanent licensee and must be submitted by the nonprofit civic organization, charitable organization, municipality or county as part of its completed application. Section 6: Affidavit of Applicant for Temporary Permit Affidavit of Section 6,the affidavit of applicant for temporary permit, must be read and signed by Applicant for an officer of the applicant organization in the presence of a notary,with the notary's Temporary seal affixed. Permit Section 8: Attestation By Permanent Licensee For Use Of Licensed Premises As A Attestation By Permitted Temporary Event Permanent When the event will be held at a location currently licensed for the sale of alcoholic License beverages,the attestation in Section 8 of this.application must be signed by the Holder current, permanent licensee and must be submitted by the nonprofit civic organization, charitable organization, municipality or county as part of the completed application. INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 9/2019 DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE i 1 SEGY7lO 7 AF IDA�IT OF 40PLI AN7'FOR;SPE IAA SALES LICENSE. O7ARIZAT�IQN REQUIRE : ` Full Name of Applicant(s) "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 perjury as provided for in sections 559.791,562.45,and 837.06,Florida Statutes,that the foregoing information is true and correct." Signature of Applicant/Affiant STATE OF COUNTY OF Sworn to (or affirmed)and subscribed before me this day of , 20 , by (print affiant name). ( ) Personally Known ( )Produced Identification i Type of Identification Produced Signature of Notary Public—State of Florida Name of Notary Public—Typed, Printed, or Stamped (NOTARY SEAL) Commission Expire"s:�" = FOR DIVlSlON USE ONLI� �` � & _F5_ » .,ter. DATE ACCEPTED BY DISTRICT OFFICE: i i INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 912019 DBPR ABT—6003' APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE Temporary Permit '❑ Special Sales License T Q1A'APPLICANIN OFOF RMATION . _ a[s-,sz�<r :r•ac.e G ..w,,.-, `:"u3.r�es.rr.. •._�assexr�.rs:e_ e.- Full Name of Applicant(s) The permit will be issued in the name of the applicant as provided on the application. ULLL\���S c�k- � �2�-2C �• �j�5 LI.L �tw\� �,uv��a�v� Applicant Mailing Address City County State Zip Code ��. Cst S k_�wr✓� e FL ' 3qq e 1 Applicant Telephone Number Applicant E-mail Address -Corporation or,Other Legal Entity If the applicant is a corporation or other legal entity,enter the name and the document number related to the legal entity as registered with the Florida Department of State Division of Corporations. IN:Number Florida Department of State Document Number ( F' k-s 3'4`' s^ c`» rt*- wK+-:K �r,.gat z-ww..' "�`c"�s"'° 4.:'•# v ��w .. xy. F�# E *, SECTION P1B�`�OTiONAL} DESIG[VATED CONTACT Y 4 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 contact person will be permitted to make changes to the application paperwork 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 designated contact. Full Name of Designated Contact Designated Contact Mailing Address S �:aLP�� s �� � City County _ State Zip Code FL Designated Contact E-mail Address Designated Contact Telephone Number Ext. I INCORPORATED BY REFERENCE:61A-5.0013, F.A.C. EFFECTIVE 9/2019 DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE TION 5: DESCRIPT►ON�OFP R M ES O'TEM'�PORY EVENT- Full Name of Applicant(s) Name or or Title of Temporary Event 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,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. t I INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 9/2019 1 DBPR ABT-6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE SEC LION 4LO -ONING APPRd AL TO BE GOMPI.ET�D,BY,�THFZON N"fl#�THORITX GOVERNING�TFIE�; P�ORARI(EVEN7'LOCATION Location of Temporary Event Street Address City County State Zip Code . Sk- 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 y Printed Name fy)elr�Sr+ Ic )CL Title Date 1s 9-0 i INCORPORATED BY REFERENCE:61A-5.0013, F.A.C. EFFECTIVE 9/2019 DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE. � � r��-�S�C ,ION 2=DA?EsAN�3CAT�l�O �OEZ QERM TOR LICE Dates of Active Use for Temporary Permit or Special Sales License Provide the date(s)of the event or sale when the permit or license will be effective. The dates provided may not exceed three days. Day 1 Day 2 Day 3 -a - �� Address for Physical Location of Temporary Event or Special Sales Event 17b� praa.r� N1J . city. County State Zip Code Is the event location currently licensed for sales of alcoholic beverages under a permanent license issued by the Division? Yes ❑■ No Q If yes,obtain attestation of permanent license holder in Section 8. SECTI N 3°S+ALESTAX CETIFtCATI N * � � Full Name of-Applicant(s) Q e.J• as c� �:�� i�r� Zr1 Florida Department of Revenue Verification of Registration The named applicant(s)for a temporary permit or special sales license has complied with Florida Statutes concerning registration for Sales and Use Tax and has paid or agreed to pay any applicable taxes due. Authorized Agency Signature Printed Name Title, Date, INCORPORATED BY REFERENCE:61A-5.0013, F.A.C. EFFECTIVE 912019 DBPR ABT-6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE y �SECT10N�i6 AFFIDAVIT OF APPLICANT FOR TEMPORARY PERMIT S� � '�n�c � �� � NO.,,TARIZAf10NfREQIIIREb r'.'I::ti.za.��.���-�_�...�-ds.:.�a�.�_ - -..._:r4,:..- sue-� ..;�rL_ _�1..;:� -•�3�.::L,�P•lg',:.> � - - Full Name of Applicant(s) - J,— \-\1 . -,�--o• "-4� "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 j 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 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 perjury as provided for in sections 559.791,562.45,and 837.06,Florida Statutes,that the foregoing information is true and correct." Signatdr,dof Applicant/Affiant STATE OF is I COUNTY OF Al. Sworn to (or affirmed) and subscribed before me this day of �n_!}tPy�n ,o.� , 20 ,2n , by (print affiant name). ( ✓ ) Personally Known ( ) Produced Identification Type of Identification Produced n ' u e of of ubli -State of Florida E ROBIN JOY DRUMSNotary Public-State of Florida Commission#GG 217747 F` My Comm.Expires Sep 11,2022 Bonded through National Notary Assn. Name of Notary Pub'c-Typed, Printed, or Stamped (NOTARY SEAL) Commission Expires: b,R I i -4 - � ._� I DATE ACCEPTED BY DISTRICT OFFICE: INCORPORATED BY REFERENCE:61A-5.0013, F.A.C. EFFECTIVE 9/2019 DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE . LA11NSND,R�EGU �T OV" S'REaAT . ED TOE E SPA DI � AL-�SALES,LICENS� Florida Law for Special Sales Licenses Pursuant to section 561.20(12)(a), Florida Statutes, upon the filing of an application and payment of a fee of$25 per license,the division may issue a license authorizing the sale of alcoholic beverages in sealed containers only,for a period not to exceed 3 days. This license is issued only for the purpose of authorizing: a sale pursuant to levy and execution; a sale by an insurance company in possession of alcoholic beverages; a bankruptcy sale; a sale resulting from a license suspension or revocation; a sale of damaged goods by a common carrier; a sale by a bona fide wine collector; or a sale pursuant to Part V of Chapter 679, Florida Statutes. F IONAL�MSTRUC.�TIO IS FOWSPEC��1 ADDITIONAL INSTRUCTIONS Registration of Legal Entity All corporations, domestic or foreign, general partnerships, limited liability companies, limited liability partnerships, and limited partnerships seeking a license are required to be registered with the Florida Department of State, Division of Corporations. The application will be considered incomplete without this active registration. For further information, contact the Department of State at(850)488-9000 or www.sunbiz.org. Sales Tax Certification Section 3 must be completed by the Florida Department of Revenue confirming that the Section 3: applicant has complied with the Florida Statutes concerning registration for Sales and Sales Tax Use Tax and has agreed to pay any applicable taxes due. Applications must be Certification submitted within 90 days of DOR approval. The address and other contact information for Department of Revenue area offices can be found at: http://dor.myflorida:com/dor/taxes/servicecenters.htmi. Affidavit of Applicant for Special Sales License Section 7; Section 7, affidavit of applicant for special sales license, must be read and signed by Affidavit of the individual applicant, every partner of a general partnership,.every general partner of Applicant for a limited partnership, a managing member, manager, or officer of a limited liability Special Sales company, a managing member, manager, or officer of a limited liability partnership, or License an officer of a corporate applicant, in the presence of a notary,with the notary's seal affixed. INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 912019 DBPR ABT—6003 APPLICATION FOR TEMPORARY PERMIT OR SPECIAL SALES LICENSE TO PREPARE FORM DBPR ABT—6003: All fields must be completed. If a question on the form is not applicable, insert"N/A." The form must be signed by the applicant prior to filing the application with the Division. TO SUBMIT FORM DBPR ABT—6003: The completed, original application must be submitted, by mail or hand delivery, to a Division District Office serving the location of the licensed premise address at least seven days prior to the first day of the planned event to ensure the permit is issued by the requested event date. District Office contact information is available at: h_ttp://www.myforidalicense.com/Di3PR/alcoholic-beverages-and-tobacco/. LAWSgNDREGUL/TiONS�R�ELATEDTOTHE7ENIPORAR'yl(aERMIT � I Florida Law for Temporary Permits Pursuant to section 561.422, Florida Statutes, upon the filing of an application and payment of a fee of $25 per permit,the division may issue a permit authorizing a bona-fide nonprofit civic organization, charitable organization, municipality, or county to sell alcoholic beverages for consumption only on premises for a period not to exceed 3 days,subject to any state law or municipal or county ordinance regulating the time for selling such beverages.Any such civic organization, charitable organization, municipality or county may be issued up to twelve temporary permits per calendar year, except in those counties or cities with special acts governing the number of permits allowed.annually. Information regarding the cities and counties with applicable special acts can be found at: http://www.myforidalicense.com/DBPR/alcoholic-beverages-and-tobacco/. Purchases of Alcoholic Beverages and Related Records The permitted bona-fide nonprofit civic organization, charitable organization, municipality, or county may purchase alcoholic beverages from a distributor or vendor licensed under the beverage law. All records of alcoholic beverage purchases and sales must be retained for examination upon request of the Division of Alcoholic Beverages and Tobacco. Sales of Alcoholic Beverages and Related Revenue All alcoholic beverage sales transacted under the authority of the permit must be made by responsible members of the permitted organization, only during the permitted time frame, and only at the permitted location. All net profits from sales of alcoholic beverages collected during the permit period must be retained by the permitted nonprofit civic organization or charitable organization. When a temporary permit is issued to a municipality or county, all net profits derived from sales of alcoholic beverages during the permit period must be donated to a nonprofit civic or charitable organization within 90 days after the event. Changes to the Permitted Event Date(s) or Event Venue If, before the first day of the event date,the permitted event is rescheduled for reasons outside the control of event organizers, the applicant organization must notify the Division within 14,days of the cancellation to be eligible for reissuance of the,temporary permit on the rescheduled date(s)at no additional application fee. If the permitted venue becomes unavailable and a new venue is chosen,the city or county zoning authority serving the new event venue must complete a new Section 4 of this application confirming zoning approval. i INCORPORATED BY REFERENCE:61A-5.0013,F.A.C. EFFECTIVE 9/2019