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299 Atlantic Blvd 0 (M Shack) 2014 Doggie Dining CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ±� ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00100006 Date 2/10/14 Property Address . . . . . . 299 ATLANTIC BLVD Application type description DOG-FRIENDLY DINING APPLICATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 --------------------------------------------------------------------- Application desc MSHACK DOGGY DINING FEE ------------------------------------------------------------------ Owner Contractor - ------------------------ ----------------------- SOUTHCOAST CAPITAL PTNRSHP LTD OWNER 1600 INDEPENDENT SQUARE JACKSONVILLE FL 322025018 -------------------------------------------------------------- Permit DOGS ALLOWED OUTDR FD SERV ARA Additional desc DOG DINING EXP 10/01/2014 Permit Fee . 00 Plan Check Fee . 00 Issue Date . . . . 2/10/14 Valuation . . . . 0 Expiration Date . . 2/11/15 -------------------------------------------------- Special Notes and Comments PERMIT MUST BE RENEWED EVERY YEAR AND IS VALID UNTIL OCTOBER 1 . QUATERLY INSPECTIONS WILL BE DONE. PERMIT VALID UNTIL OCTOBER 1, 2014 . MUST COMPLY WITH ATTACHED REQUIREMENTS . ------------------------------------------------------ Other Fees . . . . . . . . . DOGS DINING INITIAL FEE 175 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ------ Permit Fee Total . 00 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 175 . 00 175 . 00 . 00 . 00 Grand Total 175 . 00 175 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CtOGaf;Vfan�ic Seae6 J FRIENDLY RESTAURANT PERMIT APPLICATION z (Per Ordinance No.95-10-102) r!J{ DIAGRAM OF DESIGNATED DOG-FRIENDLY OUTDOOR SEATING AREA In the space below,provide a diagram (to scale)of the designated outdoor seating area showing the following: • Boundaries of the designated dog friendly outdoor seating area with dimensions, to scale • Boundaries of any non-designated outdoor seating area with dimensions, to scale • Number and placement of tables,chairs and restaurant equipment • Location of entryways to and exits from all designated and non-designated outdoor areas • Location of all fences and/or barriers • Location of property lines and public rights-of-way,including sidewalks, curbs,common pathways and public improvements, such as benches,fire hydrants,etc NAME OF ESTABLISHMENT T1 LA,, G /%A '5 1'a C K, FL DHR# a cK__ - 1 n ou4d X_ 1' ��Q J x � X x 0x Inspected&Approved by: PLICATION 1ST QTR 2ND QTR 3RD QTR 4TH QTR APPROVAL INSPECTION INSPECTION INSPECTION INSPECTION DOG v2011.01 tOG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordinance No.95-10-102) Ian J? PRE-APPLICATION CONSULTATION GENERAL REGULATIONS,COOPERATION, ENFORCEMENT AND PENALTY NAME OF ESTABLISHMENT moi. ,lam_ f C� LL Q FL DHR# 1 The applicant agrees and confirms that the public food service establishment and the designated outdoor area shall comply with all permit conditions and the approved diagram, and that permits shall be conspicuously displayed in the designated outdoor area. [Section 24-158(e)(1);(e)(2)] The applicant agrees and confirms that dogs shall not be permitted to travel through indoor or undesignated outdoor areas of the public food service establishment, and ingress and egress to the designated outdoor area shall not require entrance into or passage through any indoor or undesignated portion of the public food service establishment. [Section 24-158(e)(5);0(2)c] 3. The applicant agrees and confirms that at all times while the designated outdoor area of the public food service establishment is available to patrons and their dogs,at least one sign shall be posted in a conspicuous and public location near the entrance to the designated outdoor area,the purpose of which shall be to place patrons on notice that the designated outdoor area is currently available to patrons accompanied by their dog or dogs. The mandatory sign shall be printed in an easily legible typeface of not less than thirty-six (36) point font size, and the lettering must be in a contrasting color to the sign background so as to be clearly visible and readable. [Section 24-1580(1)] • The applicant agrees and confirms that at least one sign reminding employees of the applicable rules as discussed in this consultation and listed in Section 24-158(0(2) shall be posted in a prominent location frequented by employers within the public food service establishment. The mandatory sign shall be printed in an easily legible typeface of not less than thirty-six (36) point font size and the lettering must be in a contrasting color to the sign background so as to be clearly visible and readable. [Section 24-1580(1);0(2)] 5. The applicant agrees and confirms that at least one sign reminding patrons of the applicable rules as discussed in this consultation and listed in Section 24-158(f)(3) shall be posted in a prominent location within the designated outdoor area of the public food service establishment. The mandatory sign shall be printed in an easily legible typeface of not less than thirty-six(36)point font size and the lettering must be in a contrasting color to the sign background so as to be clearly visible and readable. [Section 244580(1);0(2)] 6. The applicant agrees and confirms that employees shall wash their hands promptly after touching, petting, or otherwise handling any dog. Employees shall be prohibited from touching, petting, or otherwise handling any dog while serving food or beverages or handling tableware or before entering other parts of the public food service establishment. [Section 24-1580(2)a-b] • The applicant agrees and confirms that patrons in a designated outdoor area shall be advised that they should wash their hands before eating. Waterless hand sanitizer shall be provided at all tables in the des' nated outdoor area. [Section 24-158(e)(3);0(3)A • The applicant agrees and confirms that employees and patrons shall be instructed that they shall not allow dogs to come into contact with serving dishes, utensils,tableware, linens,paper products, or any other items involved in food service operations. [Section 24-1580(2)d;0(3)c] DOG_v2011.01 Page 1 of 2 Ci j of Affanfic �eac6 DOG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordinance No.95-10-102) PRE-APPLICATION CONSULTATION GENERAL REGULATIONS,COOPERATION,ENFORCEMENT AND PENALTY NAME OF ESTABLISHMENT rY\5 i L-�-C, /L1 S h n C, FL DHR# If 9 e applicant agrees and confirms that patrons shall be instructed to keep their dogs on a leash and under reasonable control at all times. Patrons shall not leave their dogs unattended for any period of time. All dogs shall wear a current license tag or rabies tag and the patron shall have a current license or rabies certificate immediately available upon request. [Section 24 158(e)(7);(f)(3)a b] 10. The applicant agrees and confirms that employees and patrons shall be instructed that dogs shall not be allowed on chairs,tables, or other furnishings. Dogs must remain on the floor/ground level and shall not be permitted in the lap of the patron. [Section 24-158(f)(2)e;(f)(3)d] 1. The applicant agrees and confirms that all table and chair surfaces shall be cleaned and sanitized with an approved product between seating of patrons. Spilled food and drink shall be removed as soon as possible,but in no event less frequently than between seating of patrons at the nearest table. [Section 24-1580)(2)f-g] 2. The applicant agrees and confirms that employees and patrons shall be instructed that accidents involving dog waste shall be cleaned immediately and the area sanitized with an approved product. A kit with appropriate materials for this purpose shall be kept in the designated outdoor area. Dog waste shall not,be carried in or through any indoor portions of the public food service establishment. [Section 24-158(e)(4),(f)(2)h;())(3)e] The applicant agrees and confirms that a permit issued pursuant to this part shall not be transferred to a subsequent owner upon the sale or transfer of a public food service establishment, but shall expire automatically upon such sale or transfer. The subsequent owner shall be required to reapply for a permit pursuant to this part if such owner wishes to continue to accommodate patrons' dogs. [Section 24458(d)(3)h] 4. The applicant agrees and confirms that in accordance with section 509.233(5), Florida Statutes,the Community Development Director shall provide the Division of Hotels and Restaurants of the Florida Department of Business and Professional Regulation with a copy of all approved applications issued pursuant to this part. Further, the Community Development Director shall accept and document complaints related to the Dog Friendly Restaurant Program within the City, and shall timely report to the Division of Hotels and Restaurants, all such complaints and City's enforcement response to such complaint. [Section 24-158(8)] 5. The applicant agrees and confirms that failure to comply with the requirements of this pre- application consultation shall be a violation of the Code of Ordinances and shall be subject to any and all enforcement proceedings consistent with the applicable provisions of the Code and general law. [Section 24-158(d)(6)] I verify that I have received a copy of Section 24-158 of the Atlantic Beach Municipal Code of Ordinances and that I have been counseled by staff regarding my proposed application for participation in the Dog Friendly Restaurant Program. I understand it is my responsibility to ensure all employees and patrons comply with all regulations at all times,and that failure to comply with said regulatio esult in the revocation of my Dog Friendly Restaurant Permit. VfQ kl 1-16 ANTS SIG ATURE 'APPLICANTS PRINTED NAME DATE DOG—v2011.01 Page 2 of 2 Ca f Af�an c &acki r 9 tOG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordinance No.95-10-102) DIAGRAM OF DESIGNATED DOG-FRIENDLY OUTDOOR SEATING AREA In the space below,provide a diagram (to scale)of the designated outdoor seating area showing the following: • Boundaries of the designated dog friendly outdoor seating area with dimensions, to scale • Boundaries of any non-designated outdoor seating area with dimensions, to scale • Number and placement of tables,chairs and restaurant equipment • Location of entripuays to and exits from all designated and non-designated outdoor areas • Location of all fences and/or barriers • Location of property lines and public rights-of-zoay,including sidewalks,curbs,common pathways and public improvements, such as benches,fire hydrants,etc NAME OF ESTABLISHMENT 1 �. FL DHR# dooV X X X X 0X x x Inspected&Approved by: PLICA ON 1ST QTR 2ND TR 3RDQ1x4T APPROVAL INSPECTION INSPECTION INSPECTION INSPECTION DOG v2011.01 j o f;Vfantic �eac4i ' DOG FRIENDLY RESTAURANT PERMIT A Y PPLICATION (Per Ordinance No.95-10-102) PRE-APPLICATION CONSULTATION GENERAL REGULATIONS,COOPERATION,ENFORCEMENT AND PENALTY NAME OF ESTABLISHMENT � ' �� Cj L��� FL DHR# 1 - 1 The applicant agrees and confirms that the public food service establishment and the designated outdoor area shall comply with all permit conditions and the approved diagram, and that permits shall be conspicuously displayed in the designated outdoor area. [Section 24-158(e)(1);(e)(2)] The applicant agrees and confirms that dogs shall not be permitted to travel through indoor or undesignated outdoor areas of the public food service establishment, and ingress and egress to the designated outdoor area shall not require entrance into or passage through any indoor or undesignated portion of the public food service establishment. [Section 24-158(e)(5);0(2)c] 3. The applicant agrees and confirms that at all times while the designated outdoor area of the public food service establishment is available to patrons and their dogs,at least one sign shall be posted in a conspicuous and public location near the entrance to the designated outdoor area,the purpose of which shall be to place patrons on notice that the designated outdoor area is currently available to patrons accompanied by their dog or dogs. The mandatory sign shall be printed in an easily legible typeface of not less than thirty-six (36) point font size, and the lettering must be in a contrasting color to the sign background so as to be clearly visible and readable. [Section 24-1580(1)] • The applicant agrees and confirms that at least one sign reminding employees of the applicable rules as discussed in this consultation and listed in Section 24-158(f)(2) shall be posted in a prominent location frequented by employers within the public food service establishment. The mandatory sign shall be printed in an easily legible typeface of not less than thirty-six (36) point font size and the lettering must be in a contrasting color to the sign background so as to be clearly visible and readable. [Section 24-1580(1);0(2)] 5• The applicant agrees and confirms that at least one sign reminding patrons of the applicable rules as discussed in this consultation and listed in Section 24-158(f)(3) shall be posted in a prominent location within the designated outdoor area of the public food service establishment. The mandatory sign,shall be printed in an easily legible typeface of not less than thirty-six(36)point font size and the lettering must be in a contrasting color to the sign background so as to be clearly visible and readable. [Section 24-1580(1);0(2)] 6. The applicant agrees and confirms that employees shall wash their hands promptly after touching, petting, or otherwise handling any dog. Employees shall be prohibited from touching, petting, or otherwise handling any dog while serving food or beverages or handling tableware or before entering other parts of the public food service establishment. [Section 24-1580(2)a-b] • The applicant agrees and confirms that patrons in a designated outdoor area shall be advised that they should wash their hands before eating. Waterless hand sanitizer shall be provided at all tables in the des' nated outdoor area. [Section 24-158(e)(3);0(3)A The applicant agrees and confirms that employees and patrons shall be instructed that they shall not allow dogs to come into contact with serving dishes, utensils, tableware, linens, paper products, or any other items involved in food service operations. [Section 24-1580(2)d;0(3)c] DOG-v2011.01 Page 1 of 2 CtOGo f;V�an6c 93eac6 FRIENDLY RESTAURANT PERMIT APPLICATION J (Per Ordinance No.95-10-102) PRE-APPLICATION CONSULTATION GENERAL REGULATIONS,COOPERATION,ENFORCEMENT AND PENALTY NAME OF ESTABLISHMENT r)"\5 h J 1 t!L_V / AA 5 h� C <,) FL DHR# 9 0-applicant agrees and confirms that patrons shall be instructed to keep their dogs on a leash and under reasonable control at all times. Patrons shall not leave their dogs unattended for any period of time. All dogs shall wear a current license tag or rabies tag and the patron shall have a current license or rabies certificate immediately available upon request. [Section 24 158(e)(7);(f)(3)a b] 10. The applicant agrees and confirms that employees and patrons shall be instructed that dogs shall not be allowed on chairs, tables, or other furnishings. Dogs must remain on the floor/ground level and shall not be permitted in the lap of the patron. [Section 24-158(t)(2)e,(f)(3)d] 1. The applicant agrees and confirms that all table and chair surfaces shall be cleaned and sanitized with an approved product between seating of patrons. Spilled food and drink shall be removed as soon as possible,but in no event less frequently than between seating of patrons at the nearest table. [Section 24-158(f)(2)f--g] 2. The applicant agrees and confirms that employees and patrons shall be instructed that accidents involving dog waste shall be cleaned immediately and the area sanitized with an approved product. A kit with appropriate materials for this purpose shall be kept in the designated outdoor area. Dog waste shall not be carried in or through any indoor portions of the public food service establishment. [Section 24-158(e)(4);(f)(2)h;(f)(3)e] The applicant agrees and confirms that a permit issued pursuant to this part shall not be transferred to a subsequent owner upon the sale or transfer of a public food service establishment, but shall expire automatically upon such sale or transfer. The subsequent owner shall be required to reapply for a permit pursuant to this part if such owner wishes to continue to accommodate patrons' dogs. [Section 24-158(d)(3)h] 4. The applicant agrees and confirms that in accordance with section 509.233(5), Florida Statutes,the Community Development Director shall provide the Division of Hotels and Restaurants of the Florida Deparun,6nt of Business and Professional Regulation with a copy of all approved applications issued pursuant to this part. Further, the Community Development Director shall accept and document complaints related to the Dog Friendly Restaurant Program within the City, and shall timely report to the Division of Hotels and Restaurants,all such complaints and City's enforcement response to such complaint. [Section 24-158(8)] 5. The applicant agrees and confirms that failure to comply with the requirements of this pre- application consultation shall be a violation of the Code of Ordinances and shall be subject to any and all enforcement proceedings consistent with the applicable provisions of the Code and general law. [Section 24-158(d)(6)] I verify that I have received a copy of Section 24-158 of the Atlantic Beach Municipal Code of Ordinances and that I have been counseled by staff regarding my proposed application for participation in the Dog Friendly Restaurant Program.I understand it is my responsibility to ensure all employees and patrons comply with all regulations at all times,and that failure to comply with said regulatio esult in the revocation of my Dog Friendly Restaurant Permit. ANT'S SIG ATURE APPLICANT'S PRINTED NAME DATE DOG v2011.01 Page 2 of 2 PA� � Go CiJ a f�(f�antic Seac�iDOG FRIENDLY RESTAURANT PERMIT APP(Per Ordinance No.95-10-102) 1. FOOD SERVICE ESTABLISHMENT INFORMATION: NAME OF ESTABLISHMENTmsy-)Q FL DHR# PROPERTY ADDRESS - L�d4 AB BTR # CITY,STATE,ZIP A+ ain+i G PHONE# a + , O( 5 1 EMAIL ADDRESS C Q QiFAX # iM hQ� @ . kka�h,e,�, 3 S r e� + Co M 2. APPLICANT INFORMATION: n 7 u niittal NAME OF APPLICANT Y��l llt' � ) X Requirements COMPANY ] MAILING ADDRESS Application Fee: $175 F CITY,STATE,ZIP a 7?2Completed Permit EMAIL ADDRESS a�f�(\Q 0—Aa,, T-4UR 1 Application Farm l PHONE# OH a b . '2I 3 FAX # q�� J-1 ,5�2 Proof of Ownership F Authorized Agent 3. PROPERTY OWNER INFORMATION,,IF DIFFERENT FROM APPLICANT: Affidavits(if applicable) F NAME OF OWNER -V Proof of Insurance F COMPANY Q ��es� ,crp Diagram of Designated MAILING ADDRESS Outdoor Dining Area CITY,STATE,ZIP io,Ci 1 L-- Completed Pre-Application F EMAIL ADDRESS Consultation Form PHONE# 9 014 19 4, FAX # I V-1. � �, O�� 4. PROOF OF OWNERSHIP: 6. DAYS &HOURS DOGS ALLOWED: Please check the box of the applicable document and attach a copy to this form. J� DUVAL COUNTY PROPERTY RECORD CARD r DUVAL COUNTY RECORDED DEED ("SUN I (kM -- I O PM MON I Q Vyj - I O M 5. PROOF OF INSURANCE: TUE kk qAA _ Ia Please provide an original certificate of insurance,or have your agent fax a copy of your certificate providing �A commercial general liability insurance in the amount of five hundred thousand dollars ($500,000.00) per OWED — L 0 M occurrence and one million dollars ($1,000,000.00) aggregate. The policy shall not have exclusions for ("THU I r QM animal bites. All insurance shall be from companies duly authorized to do business in the State of Florida. Thirty(30)days written notice must be given to the City of Atlantic Beach Risk Management prior to any eFRI 1 a bAO cancellation or reduction in policy coverage. The City of Atlantic Beach Risk Management(800 Seminole SAT 11 aI Q M Road,Atlantic Beach,FL 32233)must be listed as a certificate holder. I HAVE READ THE INFORMATION IN THIS APPLICATION AND UNDER PENALTIES OF PERJURY,I DECLARE THAT THE FACTS STATED IN THIS APPLICATION ARE TRUE. APPLICANTS SIGN URE APPLICANTS PRINTED NAME DATE DOG v2011.01 Ci o f X(fan6c &ac4 ''r f OG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordinance No.95-10-102) � r AUTHORIZED AGENT AFFIDAVIT Z b 14 6-7`( NAME OF ESTABLISHMENT (2) LLL' M c5 .4 C� FL DHR# AUTHORIZED AGENT'S NAME(PRINTED) is hereby authorized to ACT ON BEHALF OF SOtJF14CPPS7- 64PCT!JL j9P Tr-MtZSIJI P LT-D ,the owner(s)of those lands described within PROPERTY OWNER'S NAME(PRINTED) the attached application,and as described in the attached deed or other such proof of ownership as may be required by the City of Atlantic Beach,Florida in applying for a DOG FRIENDLY RESTAURANT PERMIT. B / y / SI NATURE OF PROPERT1� ✓I 1 t LQS 17i� �1yaLF C P, PRINTED NAME OF PROPERTY OWNER pt�N �g� P L TfJ STATE OF l{ COUNTY OF Signed and sworn before me on this 1} day of 20 By Identification verified: Oath sworn: Yes No NOTARY SIGNATURE Y:„ AUDIAS.KIRK�D My Commission expires: ;' Mf COMMISSION#EE 008208 rs 14,2014 i Notary Public Underwriters Tbru DOG_v2011.01 STATE OF FLORIDA E DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION f DIVISION OF HOTELS AND RESTAURANTS 850-487-1395 1940 NORTH MONROE STREET NORTHWOOD CENTRE TALLAHASSEE FL 32399-1015 M SHACK HOLDINGS LLC M SHACK 2107 HENDRICKS AVENUE JACKSONVILLE FL 32207 - --- - - --------------------------— - Congratulations! With this license you become one of the nearly — - --- one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range s DEPARTMENT OF BUSINESS AND from architects to yacht brokers,from boxers to barbeque restaurants, _ PROFESSIONAL REGULATION and they keep Florida's economy strong. SEA2614679 ISSUED: 05/13/2013 Every day we work to improve the way we do business in order to serve you better. For information about our services,please log onto SEATING FOOD SERVICE(2010) www.myfloddalicense.com. There you can find more information MSAB, LLC about our divisions and the regulations that impact you, subscribe M SHACK to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your x LICENSED under the provisions of Ch.509 FS. E customers. Thank you for doing business in Florida, Expiration date : JUN 1,2014 L130513000009s and congratulations on your new license! The Department of State is leading the commemoration of Florida's 500th anniversary in 2013. For more information, please go to www,VivaFlorida.org. YiYI ft8118�',`' DETACH HERE — — - - - - — ------ STATE OF FLORIDA — - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION �j DIVISION OF HOTELS AND RESTAURANTS ��- SEA2614679 NBR. OF SEATS: 75 The SEATING FOOD SERVICE(2010) �' Named below IS LICENSED Under the provisions of Chapter 509 FS. NON- Expiration date: JUN 1, 2014 TRANSFERABLE. MSAB, LLC M SHACK 1 299 ATLANTIC BOULEVARD ATLANTIC BEACH FL 32233 VIVA FLORIDA 2012 NOTICE OF PROPOSED PROPERTY TAXES DO NOT PAY TANGIBLE PERSONAL PROPERTY Duval County, Florida THIS IS NOT A BILL MSAB LLC ~ M SHACK 299 ATLANTIC BLVD 013419 JACKSONVILLE,FL 32233-5273 TPP No:9712380700 Use: 1224 Dist: USD3 Prop.Address: 299 ATLANTIC BLVD Taxing Authority Tax Information Your Final Tax Pate - Current(2012) Your Tax Rate and Taxes Your Tax Rate and Taxes - Taxing Authority Prior(2011) and Taxes Taxable Value' This Year if NO Budget This Year if PROPOSED Taxable Value` Last Year(2011) Change is Made Budget Change is Made COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 COLUMN 6 COLUMN 7 COLUMN 8 RATE TAXES I RATE TAXES RATE TAXES County 0 6.7446 0.00 105,398 6.9443 731.92 6.7446 710.87 Public Schools: By State Law 0 5.3050 0.00 105,398 5.5523 585.20 5.3520 564.09 By Local Board 0 2.2480 0.00 105,398 2.3528 247.98 2.2480 236.93 FL Inland Navigation Dist. 0 0.0345 0.00 105,398 0.0341 3.59 0.0345 3.64 Atlantic Beach 0 3.3285 0.00 105,398 3.4550 364.15 3.4550 364.15 Water Mgmt Dist. 0 0.3313 0.00 105,398 0.3437 36.23 0.3313 34.92 SJRWMD PENALTY 0.00 0.00 0.00 TOTAL AD VALOREM PROPERTY TAXES 0.00 1,sss.07 1,s1a.6o Property • •raiser Value Information MARKET VALUE ASSESSED VALUE ASSESSED VALUE (aefom F.xa ) isefwe Exem;%�i Applies.to School Miila e Applies to Non-School Miila e PRIOR YEAR(2011) 0 0 0 CURRENT YEAR(2012) 130,398 130,398 130,398 If you feel the market value of the Applied Assessment Reduction Applies to Prior Amount 2011 Current Amount 2012 property is inaccurate or does not N /A N /A reflect fair market value as of January Save Our Homes or Portability Benefit All Taxes 1, 2012, or if you are entitled to an Agricultural Classification All Taxes N/A N/A exemption or classification that is not reflected, please visit the Duval County Non-Homestead 10%Cap Benefit Non-School Taxes N /A �� N /A Property Appraiser's Office at 231 E. Forsyth Street, Jacksonville, Florida Exemptions ies to Prior Amount 2011 Current Amount 2012 32202, call (904) 630-2011 or one of Charitable&Institutional All Taxes Q Q the numbers on the back of this notice. 255 000 If the Property Appraiser's Office is Tangible Personal Property A11 Taxes 0 unable to resolve the matter as to Additional Homestead Non-School Taxes N /A N/A the market value, classification or exemption, you may file a petition for Disability All Taxes 0 0 adjustment with the Duval County Value Adjustment Board. Petition Limited Income Senior County/Municipal N /A N/A forms are available at the address Operating Taxes above or online at www.duvalaa.com. Widow/Widower All Taxes 0 0 Petitions must be filed on or before Historic Preservation County Operating N /A N /A Taxes September 18, 2012 Deployed Servicemember Exemption All Taxes N /A N /A Nationwide On Your Side' COM-PAK SUMMARY PRINTED 03/28/2013 ONE NATIONMIDE PLAZA COLUMBUS, OH 43215-2220 Number: ACP 5906035636 Effective from o3/mmi3 to 03!26/2014 Named Insured: MSAs, LLC DBA M SHACK Mailing Address: 2107 HENDRICKS AVE JACKSONVILLE, FL 322073370 Agency Name: JAMES F TUWS&ASSOCIATES 09 59807 59 Agency Address: JACKSONVILLE FL 32207-1022 (904)39r-2041 Division Program Total Premium A COMM'L GENERAL LIABILITY(DEPOSITORS) $5,563.40 B COMMERCIAL PROPERTY(DEPOSITORS) $Z,041.76 e! of a bill.Your bill is sent separately. 1 Estimated Total Premium: $ 7,605.16 This Com-Pak is a portfolio of individual policies which serves to combine various insurance coverages written under a group of separate contracts finsurance. 59807 DEPOSITORS INSURANCE COMPANY NEW BUSINESS ONE NATIONWIDE PLAZA COLUMBUS, OH 43215-2220 COMMERCIAL GENERAL LIABILITY DECLARATIONS Policy Number: ACP GLDO 5906035636 Named Insured: MSAB, LLC - DBA M SHACK Address: 2107 HENDRICKS AVE JACKSONVILLE FL 32207-3370 Agent: JAMES F TULLIS & ASSOCIAT 09-59807-002 Address: JACKSONVILLE FL 32207 PRODUCER: JAMES FOLSOM TULLIS Policy Period: From 03/26/13 to 03/26/14 12:01 A.M. standard time at the address of the named insured as stated herein. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. LIMITS OF INSURANCE $ GENERAL AGGREGATE LIMIT(other than Products-completed operations) 2,000,000$ 2,000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT $ 11000,000 PERSONAL AND ADVERTISING INJURY LIMIT $ 1,000,000 EACH OCCURRENCE LIMIT 100,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT(any one premises) $ 51000 MEDICAL EXPENSE LIMITany one person) $ 2,000,000 LIQUOR LIABILITY AGGREGATE LIMIT $ 11000,000 LIQUOR LIABILITY EACH COMMON CAUSE LIMIT ~� Retroactive Date (CG0002 only) The Named Insured is: LIMITED LIABILITY CO Business of the Named-Insured is: RESTURANT Audit Period: ANNUAL ENDORSEMENTS ATTACHED TO THIS POLICY SEE COMMERCIAL GENERAL LIABILITY FORMS AND ENDORSEMENTS SCHEDULE ADVANCE PREMIUM $ 5,492.00 SURCHARGES/ASSESSMENTS $ 71.40 TOTAL ADVANCE PREMIUM $ 5,563.40 Replacement or Renewal Number Countersigned By „ Authorized Representative GL-D (10-98) - - -- - 'S, CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 DOG DINING INITIAL PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-DOGS-1005 Job Type: DOG-FRIENDLY DINING APPLICATION Description: DD RENEWAL M SHACK Estimated Value: Issue Date: 2/10/2015 Expiration Date: 2/10/2016 PROPERTY ADDRESS: Address: 299 ATLANTIC BLVD RE Number: 172531-0000 PROPERTY OWNER: Name: SOUTHCOAST CAPITAL PTNRSHP LTD Address: 1600 INDEPENDENT SQ PERMIT INFORMATION: FEES: DOG DINING ANNUAL RENEWAL $125.00 Total Payments: $125.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES.