HomeMy WebLinkAboutProject Information 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 ABT-6029
Revised 02/2013
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
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&Ts web site at the link provided below:
htto://Www.mvflorida.com/dbr)r/abt/district offices/licensin4 htmI
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Transaction Type:
K Temporary Extension ❑ Amended Sketch
❑ Permanent Extension
Fr7APATAS
Elisted on alcoholic beverage license)
STAURANT LLC
me(D/B/A)
STAURANT LLC
Location Address(Street)
6200 S US HWY 1
CityCounty State Zip Code
PORT ST LUCIE IST LUCIE FL 134952
Alcoholic Beverage License Number Series Type/Class
6602071 4COP SRX
Business Telephone Number Email Address(Optional)
772-464-7288 ext,
FOR TEMPORARY EXTENSIONS ONLY:
Date(s)of Extension:
5/5/16
ABT District Office Received/Date Stamp
Auth.61A-6.0017
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Location Street Address
6200 S US HWY 1
City County Zip Code
PORT ST LUCIE ST LUCIE FL 34952
Are there outside areas which are contiguous to the premises which are to be part of the premises sought
to be licensed?" 0 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.
Q The TEMPORARY extension of the licensed premises as shown in,the sketch complies with zoning
requiremen for the sale of alcoholic beverages pursuant to this application.
t
Signed: Title: e!'/!!I /'Z Date: 02 Z6/J,
This approval is valid dl
;r � rSECTION4%tEAt.TH
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= ,� ORCOl1NTYkHFALTFIJAI)THO,RITY - � �k
The above establishment complies with the requirements of the Florida Sanitary Code.
Signed Date
Title
Agency
This approval is valid until
Auth.61A-5.0017 2
�� .� z�' �� � SEGTzCQN 5 AFFII�"/�VIT%OF�AFPI✓1C'ANT � � � `` � ``� �
Business Name(D/B/A)
ZAPATAS RESTAURANT
"I, 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 applying for a temporary extension, check the box to confirm the following statement:
■0 "I understand that the premises must be restored to its original form at the conclusion of the
authorized temporary event."
STATE OF F L
COUNTY OF ST L U C I E
r
APPLICANT41GNATDRE
APPLICANT SIGNATURE
The foregoing was( )Sworn to and Subscribed OR(%/)Acknowledged Before me this �' Day
of Aar,, , 20 /6 , By J �Cli �®�f; i3�Z who is personally
(print name(s)of person(s) makinj statement) .
known to me OR(✓)who produced as identification.
Commission Expires:
ry Pu lic
" "'•••,, HEIDI BAIRD
�? Notary Public-State 01 Ftoft
• My Comm.Expires Nov Is.28j?
Commission#FF 3842!
Bonded Thr
oONatlgdNolryAlw
Auth.61A-5.0017 3
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•�.;': �r._''`=as_, :.., >�., ._�Pk:,` � ..�.n :�_" �. �*"7. ...,?.'�,��:-:.:r'``�.�s �``.erv,�:.s b� ,`.s. � ' ;b`'�° us � � , -�
Business Name(D/B/A) `
1. Yes ❑■ No❑ Is the proposed premises movable or able to be moved?
2. Yes ❑ No❑p Is there any access through the premises to any area over which you do not
have dominion and control?
3. Yes ❑ No p Are there more than 3 separate rooms or enclosures with permanent bars or
counters?
4. Yes ❑ No❑p 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. 11
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.
7-11
Auth.61A-5.0017 4