HomeMy WebLinkAboutZoning Compliance Mobile Food Vendor 2 I Ce 0 - 0- 4
Permit Fee: $75.00
Receipt#:
ST.LUCIE COUNT J&ANNING&jDEVEL�OPMENT SERVICES
_ BiJILDING'&CODE REOULATIONS'DWMON
2300 VMGINIt1AAYENM
FORT PIERM PL 34982-5652
772462-1553
APPLICATION FOR CLASS H MOBILE FOOD VENDOR
ZONING COMPLIANCE
Date: J41Q
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Business Name: ` r ` C+� ' V` e
Business Address: / A r r
City: P rCe State: �f • Zip: �t�hone no: 2 `t — 3V
Description of Mobile Food Business:
Previous Business: v�S _ P—-.V` tagCi•l j
Applicant's Name...
(! < <, _ 1,� Phone:
Applicant's S Address: _ v �✓
City: hC state zip:
Property Tax Identification M
I hereby acknowledge that the above is correct and agree to conform to the StAucieCountyBuilding
and Regulations Code.
**COPY OF•STATE.OF.FLORIDA FOOD HANDLER'S.LICENSE MUST ACCOMPANYTHIS APPLICATION.
Applicant's Signat4re `
Date: _ initials•
Zoning: Land Use: SIC Coder` Site;Plan:
Subdivision: Lot: Block: SwMin/Rng:
Certificate of Competency Required.Yes No Number. Type
Landscaping Required:Yes- No Building. 'pe: CBS Wood frame
Building&Regulations Code Division,Code Enforcement Officer
SLCPDS Revised 5/19/2010 i
iii .
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Plot Plan : .
F PV
-Ce6k TRAIUS 4;
Lot size
dimensions
Ll
C�
5TALL,S
� 7
Lot size dimensions
• ��*�r�iz■'s.■��air�•rsafiiiwM Ni-nuaesttarisax ssWiisuasrirsariiwurnum Mang Sam■•,rseEaN■ �
Office Use.:oniy
S
ProP: rty.
a dimensions
.:
Locatian'of ESistirig Structures and Ground Signs
Location of Mobile Food Facility and Setbacks to Property Line
Parking
.Landscaping
SLQ'DS Revised 85/1912010 i
7 i
State of Flort a
} Department of State
,
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I certify .from the records of this office that GRIP�& RIP GOLF RANGE
is a Fictitious Name registered with the Department ,of State on
September 8, 2016.
The Registration Number of this Fictitious Name is G16000098261.
I fiu ther certify that said Fictitious Name Registration is]active.
I fiirther certify that this office began filing Fictitious Name
Registrations on January 1, 1991, pursuant to Section;, 865.09, Florida
Statutes. i
'i
l
i
Given under my hand and the Great Seal of
Florida, at Tallahassee, the Capital,this the Ninth
day of September,2016
KI
Secreta
' of State
;
Authentication ID:400290008884-0909,16-G1'6000098261
,f
To authenticate this certificate,visit the following site,enter this
ID,and then follow the instructions displayed
https:llefile.sunbiz.org/certatithver:html
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Pre vv+n/w,Premiel-FoodSafet .com
[ mierFoodSafety in partnership tivithThe New Habit y
ii Protecting people's lives for over 35 years triodda Provider u 39'S435) (800) 676-3121
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This certificate recognizes that
- _Claudia Brown!.
Belvin Holdings Inc.
has successfully completed and passed the
Florida Fo'od, mandle' r
sTraining. Prog'rate
;,
certified Food Manager., The New Habit Byong W.Yoo,PhD(Founder)
Date of Birth: 01/24/66 I( Florida Provider Number. 3913435
Issue Data: 12/04/2014 Confirmation: 1412030166
Explretion Date: 12104!2017
This certificate meats the requirements for the Florida Food Service Employee;Training. Verification Code: 2014-TZIURN
1....s rU
!PreRlieri;'.00d$dfety.~in Partnership wirhThe New Habit
r {c,`r u.c'::!.�a•' fnorida Ft�eF]flbi
Florida Faced Handler
Training Certificate
Claudia Brawn
Belvin Holdings Inc.
Ceffed Food Manager The New Habit Florida Provider Number. 3913436
K Date of Binh: 0124166 confirmation: 1412030166
Issue Dela: "1210,12014 Verification Code: 2D14MIURN
;a apkation Date: J=412017
www.PremierFoodSaiety.com (600)676'-3121
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PremlerFoodfet / w.Premipr',�: r�
aodSafety.cm
' (8001676-3171 i
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S Description of;a.,Mobilo Fbod Dopettsmg Wait'
Any food.seryicc.establishmeot,t at is self propelled or otherwise mogeable frpmplaceto.,piace,,Oat is ,
se>!'contained.nntd 0999#0use.eiectrical•or other ntditynnnectioas.of Dnp kiatl,l in which l`ood>s
prepared'xnyoX,dispegsed,end#hat topuplies tvitis all agpiicabie cegaements.s(epi fort�t by.,the,Floridu
I Department of Businem Regulations,d"Ion.of Hotels and Restaurants,or its saeoessor.agency,'
! including but not limited to'those regulations set forth.in Rale 7C-1.43,Florida A ministrative Code.
Property Owner Information:
NaMe• Fort Pierce Driving Range Property, LLC Phone 9P 54-623=6347
Address: 6460 NW 6:4nd Terrace (
E Ci1,yy: Parkland' State: ' YIP Codec" '33067 ..
Dane:.
'CJimenez,Jimnez, as President of,owner of tttE fcilloovinig dsc'cibed,property,autbo
• ,, ., , : , • j••:,.':; I I . ;. rite,
Grip. NRig to pace a mobile food/ rodnc' y
„ I e.iiulit'oit•nii properjty.
Property•Ta�cIdefitfta6nft 1 2;,1_3 -0003=-000 : 2�1-323_OOQ2-0o0�' 1441 3 3 0001--000/5
Legal D"Crlptione, see attached ,.
Fort Pierce;Driving' Range
Property, td,(i•
Proorty.Owueps Nab&(inesseprint)_ Pteperfy;Owuer's:Siggatulre;.. ,.
Cristobal Jimenez, ''resident'
S`tate-ofFlorida;Co�rntp'of ' Bro4ard
The foreg►ofug itiiafiF aent'was hdm' ledg belt r6 me this ....................7 —dity of Oct: 20 '16
who1is personally knowh to m or who has produced—
as identirkati'ion.
: arpNii so sinataNo
sy'
: NdtarvPubhc ; . MERRYDAC
Col' mn NvftbzTiteS229 .,!�
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l tX-tHES:August 30,2019
ty ' flowed Thru,NDhty Public Under v&M
SLCYUSRavisad US/i9/1i110'
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