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Permit Tent LA Fitness 983 Atlantic Blvd 2012 CITY OF ATLANTIC BEACH s 800 SEMINOLE ROAD ;r ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number 12-00000838 Date 7/03/12 Property Address . . . . . . 1021 ATLANTIC BLVD Tenant nbr, name . . . . . . 983 LA FITNESS TEMP OFFICE Application type description TENT PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc TEMPORARY TENT - 7-3-12 TO 7-11-12 ONLY ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ EQUITY ONE ATLANTIC VILLAGE, OWNER 16 NE MIAMI GARDENS DR ATTN: TREASURY DEPT MIAMI BEACH FL 33179 ---------------------------------------------------------------------------- Permit . . . . . . TENT PERMIT Additional desc . . TENT 7-3-12 TO 7-11-12 ONLY Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 12/30/12 ---------------------------------------------------------------------------- Special Notes and Comments TEMPORARY CANOPY TENT ONLY FROM 7-3-12 TO 7-11-12 TENT MUST BE REMOVED ON OR BEFORE 7-12-12 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 39 . 00 39 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. j!.'1}1•Ufa �s 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 � 'Z � 'Z APPLICANT NAME: GA `�r�PsS MAILING ADDRESS: _q'63 �/1� tiG l3jyd c- ,LL ADDRESS WHERE TEMPORARY TENT OR AWNING WILL BE PLACED (If different from mailing C address.) ��y e, %A DATES THAT THE TEMPOR &RY TENTS AND AWNING STRUCTURES WILL BE LOCATED ON A. THE PROPERTY: through ?-- 3--/2- 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 proper er or t Ize agent. SIGNATURE _.. PRINT NAME CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRINT) NAME jLoSh 5'0111 MAILING ADDRESS 1222-0 PHONE -Z��CD-2,!2_ &A FAX /�/tf�' E-MAIL M5,-)'\ 3 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 APPROVAL OF TEMPORARY SPECIAL EVENTS All information requested on this form must be fully addressed in order to receive approval from the City of Atlantic Beach to hold any special event by any commercial entity, non-profit, charitable, or for profit organization on private property, which involves activities exceeding normal day-to-day use of property or business operations, the use of outdoor tents, service or cooking facilities, or any expansion of the business area to an outdoor area or any parking area. Use of tents requires an additional tent registration form. In no case shall any such temporary special event extend to utilize any public property, street, sidewalk or right-of-ways. Requests to receive approval for temporary special events should be submitted to the City not less than thirty (30) days prior to the proposed event. DATE � - -zoo ` 2 BUSINESS AND APPLICANT NAME: �ajjL�/OaJ�e' tet/ ZC MAILING ADDRESS: q8 +1 c O V J ADD�AND LOCATION WHERE EVENT WILL TAKE PLACE (If different from mailing address.) REQUESTED DATE(S)FOR TEMPORARY EVENT (7- THE ZTHE BELOW SIGNATURE ACKNOWLEDGES THAT THE PROPERTY OWNER AND/OR THE COMPANY CONDUCTING SUCH TEMPORARY EVENT ASSUMES ALL LIABILITY AND RESPONSIBILITY FOR SUCH EVENT. I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT. Signature of proper owner r authorized agent. SIGNATURE PRINT NAME / ►� s,, ,'�� CONTACT INFORMATION OF PERSON SUBMITTING THIS REGISTRATION FORM (PLEASE PRINT) NAME KoA (' L / MAILING ADDRESS Z 22 Z O AA14�n W c. 1� ,�Sdr�✓�'/�{ PHONE .330`2A� ` y ,� FAX 00 E-MAIL /f;r^I)ek-0 Please provide all information as requested on the attached pages. . Y 1. What type of alcohol will be served and how? Beer? Wine? Other? Served inside? Outside? No 2. Provide approved copy of any required Alcoholic Beverage Permits from the Division of Alcohol Beverages and Tobacco? (Additional permit required by DABT for any expansion of Licensed Premises.) Ik 3. Identify the event sponsor and provide appropriate contact person in case of any emergency. M-/_4 41411 de k 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. T /yd`s, �, 40 c",)r " Le, Gct',�V n _Tc.�v 5. Has the bess consulted with neighboring businesses to obtain their approvals? us7e 5 6. Will there be outdoor music? Will there be amplified outdoor music? What hours? Vd 7. Will there be a live band? What hours? AJ d 8. How many people are expected to attend this event? 2- 9. How will crowcontrol be managed if there is an overflow crowd? 4rkr'�✓ ;S loc4�,l bei-kJ 10. What specific special events are planned? (...such as bobbing for apples; ring toss; dunking booths; wet t-shirts; bikini contts; all male/female "review")P6&-o, 1 f eserl-kfilw-S 11. How will parking be located and managed? Include site plan showing parking areas to be used for this event. ( 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. L19,14,-4- Aa II -hhc_ 196ae-� ol,`C- f� 13. How are they going to assure that all people consuming alcohol are old enough? Wrist bands? Door men? IU I A 14. Are any tents to b rected on the rop rty? (Tent registration form required.) yt 5 4�C- 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? A) 16. Will there be any extension of electricity into the parking areas, outdoor areas or any yards? 17. Special temporary events cannot negaattiivvely impact traffic flows, particularly in any adjacent residential areas, or close or block any public street or right-of-way Please address. R.CL l©o 4t �?a,y I-e> d 18. Address how fire code requirements and access for emergency vehicle be monitored and maintained at all times during the Special event. C,4. 1( _RC2 Cie fi 19. Are there going to be any fires or fireworks? A) 20. Other than service animals, are there going to be any animals allowed as part of this special event? 2 �! IV Y 21. Is this a first time event or a continuation of an anual even1t?- 22. Were they complaints or problems at prior events of this nature? 23. What additional signage will be used? (Suc as for advertising, restrooms, alcohol consumption? (City Sign regulations apply.) r©w 24. How will the event be promoted and advertised (such as through the use of fliers, TV, Radio, etc.) 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 6 1 PRINT NAME � v� i e EVENT APPROVED: REQUEST DENIED: SIGNED: DATE: Department of Public S ety SIGNED�—Im DATE: -713 Z47 ans , City Manager T 1 I� 2-01 2 at Seed tv 3