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HomeMy WebLinkAboutApplication for Zoning Compliance - Use Permit V_ rr OFFICE USE ONLY: DATE FILED: `P PERMIT#: PLANNING&DEVELOPMENT SERVICES ? ' 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: NAME OF EVENT: (�I` L'D �r ;% i'l d4 jj LOCATION AND ADDRESS OF TEMP Y USE EVENT: PROPERTY TAX IDENTIFICATION#: �yl —`fib DESCRIPTION OF TEMPORARY USE: �� G°Y � DATES OF THE EVENT: �� 162 APPLICANT'S NAME: a M 0k1 2/ APPLICANT'S STREET ADDRESS: /75/ CITY: �zla S?�r74 6'e P STATE: ZIP CODE: WILL THE EVENT HAVE A TEMPORARY LIQUOR LICENSE:YES)�—NO WILL THE EVENT HAVE A TENT(s):YES-X—NO (up to 900 square feet exempt from fire permit) g�0 WILL THE HAVE BANNERS/PENNANTS/FLAGS?YES /NO__K_ .(REQUIRES SEPARATE APPLICATION) I HEREBY ACKNOWLEDGE THAT THE ABOVE INFORMATION IS CORRECT AND AGREE TO CONFORM TO ST.LUCIE COUNTY LAND DEVELOPMENT CODE,SECTION 8.02.02J. J-1 A W.0rn /&,/,P,Cr a ez 0 � PRINT APPLICANT'S NAk SIGNAURE OF APPLICLINT v STATE OF FLORIDA,COUNTY OF Gc ACKNOWLEDGED BEFORE ME THIS DAY 0— T40-r-1l 20-4/4— BY WHO IS PEIAONALLY KNOWN TO MFjx, OR WHO HAS OD CED AS IDENTIFICATION. SIGNATURE NOTARY TYPE OR PRINT NAME OF NOTARY TITLE: NOTARY PUBLIC COMMISSION NUMBER: r F 3.84Q9 SLCPDS 06/16/2014 •""""' HEiDI BA.IRD Notary Public-State of Florida •_My Comm.,Expires Nov 16j 2o1T Commission-+li FF'3UU Baded 7hauDhN�tt�ItiotlryAelp; PERMISSION FROM OWNER OF PROPERTY DATE: 7—l5-1ep AS OWNER OF THE FOLLOWING DESCRIBED PROPERTY,I AUTHORIZE - C TO HOLD A TEMPORARY USE EVENT. 4 PROPERTY TAX IDENTIFICATION#: �(D — r,O/,5Cp�l LEGAL DESCRIPTION OF PROPERTY: c ZQ� s � .Le lc"-t PROPERTY ADDRESS: C� 7©� -� [�[S ww Cr 7"O.-T tS/. t&4f OWNER INFORMATION: PROPERTY OWNER'S NAME: (F Ie-C _ f r I�— PROPERTY OWNER'S ADDRESS: 1751 5� l�C�l�( Die CITY: �� • (' ( � STATE: ZIP CODE: --� odsue c e PRINT O R'S NAME SIGNATURE OF O STATE OF FLORIDA,COUNTY OF LZ" Cf.e ACKNOWLEDGED BEFORE ME THIS DAY OF .,20� BY WHO IS PERSONALLY KNOWN TO MEK, OR WHO HAS PRODU ED AS IDENTIFICATION. SIGNATURE OF NOTARY TYPE OR PRINT NAME OF NOTARY TITLE: NOTARY PUBLIC COMMISSION NUMBER:FF 384117 seal ,,� 11 4y4 HEIDI BAIRD SLCPDS 06/16/2014 tp�4� 4 Notary Public-State of Willa . • My Comm.Expires Nov.18,2017 Commission#FF 36131 tllxlded Throw Nftnsl __ 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 & 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.mvfloridalicense.com/dbor/abt/district offices/licensing.html 9:114'114^`+�C ��l _"' 'A"v. (�Eo Tr tion Type: ne wo/Three Day Permit ❑ Special Sales License �n ,.ros . ._ r 4tiSEC4� 2 ��' 11 i`oICF�ISE3l �,_. prt� � z k � 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) aVy7?Sq5 Full Name of Applica t(s): (This is the name the permit or license will be issued in) De artment of State Document# J nl 2cZrn P Z �O 600 Business Name D/B/A)Qr Name of Eve Location of Event(Streetand Number) (ozo S. US t4 u-3 City © County State I ZipCode Lu tl2 S L 4 FL Mailing Address (Street or P.O. Box) City State Zip Code Contact Person-This section is optional,see application instructions for details Contact sr'Aon Telephone Number 2- �� ?707-t"s3 ` G a ext. Email Address(Optional) Mailing Address(Street pr P.O. Box) a Aue n"e CityState Zip Code �o�f V• FL � Date(s)Permit Desired ABT District Office Received Date Stamp Auth: 61A-5.0013,FAC I Y � �'�;a#a_�x€�rE`� pxs �� „5`* �- s"•�..' �#��`�S.s ..�,F`T��,�9 s ns �xar^1' r Y".fi=- ` z`Se b 5- +J.Sze"`r,,�.Y�3,��.•-. ���e..atx.��1°n�rz�i�Xi �"Col�eb:t�� � �'.,r�+��.'t.1�s •�� 4*©r:Y-r'2G�'6.F�..k'""�"J.t,!'�'�I��tL�#�r!�..�.3w1,7���'L��;.S,z; '� ;'�'�"�t�a,�rr"�e"3.D�ti Full Name of Applicant Organization 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 � W Titl� � ;sA RECEIVED Department of Revenue Stamp: FLORIDA DEPT OF REVENUE FLORIDA DEPT. OF REVENUE APR 2 2 2016 GTA-COMPLIANCE ENFORCEMENT 337 NORTH US HWY 1,SUITE 207B FORT PIERCE SERVICE CENTER FT. PIERCE, FL 34950 L+'-..fit .I� ,+�,�^•.r '� f-ti �: h` 4e e a L S. +,• Location of d t Street.5d Nbg� u� � J r Citytex 611 el C tY LD The location compNs s with zoning requirements for the temporary sale of alcoholic beverages pursuant to this application /To/Three Day Permit. /m Signed ate Title -e p Note: College fraternities and sororities must meet certain additional conditions which can be found in the application instructions and requirements. Auth: SIA-6.0013,FAC 2 m r �' F � ,;'?�'�� �"',�: ,�,"`-`'��s a��•+z ..F: 3;�,_ �« �._ £ • r 'fit �v- � �: �:�-2.s.,�-.fiY, -4 �-� S •°ir`s.�R ' ��: r �' .�^' � _/5 +moi 3` s��r^--`"''L•.�` ''L.��i Y � ��fvc'iv �,:_ rte, v'"3 ' 3.._ -� ,.,1-. .�� .a '�'�'qyf° �a -Sr' .c�"�.r'�c"*t-'�. ,€ r„: -•-”' Ksf a Y� �k�� ��. � w€""£�'a �S�c,F.. �ni'v.r a y�.a '� '6�h -t,,r t.�• -, ,fir � t7 t -,_ £ � Y.,, -�,'-.� cis. ..L. �v�,�i �]� yp �t ,r��'.p r X46., r�.�„gE,,, �" .— � ? •�.k.� -awF ;,• 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 dates) 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 P ` /z.l�b� COUNTY OF � C.f • et APPLICANT/AU HO IED REPRESENTATIVE NAME V D"Y� APPLICANT/AUTFfORIZEV REPRESENTATIVE SIGNATURE -The foregoing was( )Sworn to and Subscribed before me this Day of 1 , 20�, By JPvnb who is personally known to me (print name(s)of person ma ' g statement) OR( )who produced as identification. Commission Expires: Ana0 Notary Public •iuiq , HEIDI BAIRD• NOW v Public .SI>tte ONO • My Gumm.Expires Nov 14,2017 commission#FF3UN Bonded Through Na11011r A Auth: 61A-5.0013,FAC 4 N 'SG'�ION 6•r DESGRIPTIQN4F PREMISST 0 B L.14` SED ` .'" :;'.'!"' }. ffz r',}Y?.��C �i .:;,.. Ca;,r- �.x,' NRAZ Business Name(D/B/A) 1. Yes ❑ NoIR Is the proposed premises movable or able to be moved? 2. Yes ❑ No❑ Is there any access through the premises to any area over which you do not have dominion and control? 3. Yes ❑ No W Are there more than 3 separate rooms or enclosures with permanent bars or counters? 4. Yes ❑ Nog Is the business located within a Specialty'Center? If yes,check the applicable statute: ❑ 561.20(2)(b)1, 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 where the entire building is to be licensed must show the details of each floor. I C�L I 3 !I I 1 I i 1 Auth.61A-5.0017 4