511 Atlantic blvd (bire me cupcake tene approval ) 2011 - rLl
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City of Atlantic Beach - 800 Seminole Road - Atlantic Beach,Florida 32233-5445
Phone (904)247-5800 - Fax (904)247-5845 - http://www.coab.us
REGISTRATION FORM
FOR TEMPORARY TENTS AND AWNING STRUCTURES
Within residential and commercial Zoning Districts, temporary tents and awning structures may be used
on private property within the City of Atlantic Beach following submittal of this completed form to the
Building and Zoning Department. These may be used only for private temporary events, such as
weddings and private parties and may be placed upon the property for a period not to exceed four(4) days
or ninety-six (96)hours.
DATE__/,)7///J
APPLICANT NAME: r� �f
MAILING ADDRESS: ✓� A T-1o_,+i t FEL 32-2 3
ADDRESS WHERE TEMPORARY TENT OR AWNING WILL BE PLACED (If different from mailing
address.)
DATES THAT THE TEMPORARY TENYSAWNING STRUCT RES WILL BE LOCATED ON
THE PROPERTY: ��m�/,� D through // // kl�? J
TEMPORARY TENTS AND AWNING STRUCTURES SHALL BE FULLY SECURED, AND THE
BELOW SIGNATURE ACKNOWLEDGES THAT THE PROPERTY OWNER AND/OR THE COMPANY
INSTALLING ANY TENT OR AWNING ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR
SUCH.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT.
Signature of property owner or authorized agent.
SIGNATURE, PRINT NAME R(- L
CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRINT)
NAME f- c,.._�_ti— CJ P V_�
MAILING ADDRESS 4� Z� S�r-�� �� l�� �����'� �c� I�� 32233
PHONE '?Oq � D) - -7 U 33 FAX E-MAIL, i l E NC-l"dJ,Cow.
1. What type of alcohol will be served and how? Beer? Wine? Other? Served inside? Outside? 11th-&
2. Provide approved copy of any required Alcoholic Beverage Permits from the Division of Alcohol 'I/A
Beverages and Tobacco? (Additional permit required by DABT for any expansion of Licensed Premises.)
3. Identify the eve t sponsor an rovide appropriate contact person in case of any emergency.
4. Provide a site plan depicting the layout and location of all activities, including parking and traffic flow
distribution points, any tents, fences, security check points,and location of planned events and activities.
5. Has the business consulted with neighboring businesses to obtain their approvals?
6. Will there be outdoor music? (Y)Will there be amplified outdoor music? What hours?
7. Will there be a live band? -03 What hours?
8. How many people are expected to attend this event? j 0
9. How will crowd control be managed if there is an overflow crowd?
10. What specific special events are planned? (...such as bobbing for apples; ring toss; dunking booths; wet
t-shirts; bikini contests; all male/female"review") SeVV� Ctp d 2—s�r"\
11. How will parking be located and managed? Include site plan showing parking areas to be used for this
event. Qom)-� k. ("—, l_�
12. How will security needs be provided;particularly with respect to prohibiting minors from being served.
(See following question.) Will off duty police or private security be used? Who is the contact person on-
site if problems arise? (Must be approved by City of Atlantic Beach Police Department. h( R-a�,
13. How are they going to assure that all people consuming alcohol are old enough? Wrist bands? Door
men? �
14. Are any tents to be erected on the property? (Tent registration form required.) Lyo, 5Xk_
15. Will there be any outdoor heating or cooking? If so, address how any by-products and refuse will be
handled, including grease/oil/refuse. How will any extra trash collection and disposal needs, during and
after the event,be addressed? 6_ P J, - O-L- 2 .
16. Will there be any extension of electricity into the parking areas,outdoor areas or any yards? a_c
17. Special temporary events cannot negatively impact traffic flows,particularly in any adjacent residential
areas, or close or block any public street or right-of-way Please address. VLA-vim_
18. Address how fire code requirements and access for emergency vehicle be monitored and maintained at all
times during the Special event. .
19. Are there going to be any fires or fireworks? Y\5D
20. Other than service animals, are there going to be any animals allowed as part of this special event? r10
2
21. Is this a first time event or a continuation of an annual event? 7 r`41
22. Were they complaints or problems at prior events of this nature? )VA
23. What additional signage will be used? (Such as for advertising, restrooms, alcohol consumption? (City
Sign regulations apply.) 0-(\ 7-,z-"
24. How will the event be promoted and advertised(such as through the use of fliers, TV, Radio, etc.)
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25. Acknowledge by signature below that this special event will comply with all City of Atlantic Beach laws
and ordinances and that the event will be conducted and managed as represented within this application.
Such acknowledgement extends to all those organizing,planning and staffing this event.
SIGNATURE DATE
PRINT NAME ?
EVENT APPROVED:
REQUEST DENIED:
SIGNED: DATE:
D partment f SafetjV
pec CPWVa/
SIGNED: DATE:
ans , City Manager
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