376 AHERN ST OL APP CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
LOCAL BUSINESS TAX APPLICATION
Section I
APPLICATION FOR V1 New Business L.1 Transfer Ownership I_ Transfer New Location:Previous location
BUSINESS NAME �,,fp cn ,,#II J)ro9 ccLrd e e5 Abc, 06r-4CGrr 4va.ch Alt e
LOCATION ADDRESS to NhQryr cS4 410:1 - a ZL 33 _
MAILING ADDRESS aohnp Nit x.15
BUSINESS PHONE FAX �4-'J� 1,{6' CELLS - _3y-ZE3�1 ttp I er
NATURE OF THE BUSINESS Please Be S ecific ss v;1 V
C011-IJA rvn Cf�r�r-��nD �Y, (riat- r" Fart- r coo - Pi
SQUARE FOOTAGE OF BUSINESS PREMISES q q �?75{' _
(Include both buildings and outside areas used in conjunction with the business,but not patron parking areas)
NUMBER&TYPE OF VENDING MACHINES(if any) ?6p5CGY,6k1JAA4-5.1.C$
Section 2
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER '•�2Y1 nr t! wctrc�S
HOME ADDRESS X35 I�(t�+ n �� &5, J /LA
HOME PHONE SS#or Fed Employer ID#_
DATE OF BIRTH DRIVER'S LICENSE# (Attach copy)
STATE LICENSE/CERTIFICATION/REGISTRATION#(if applicable,attach copy)
******************************************************************************************************
Section 3
1,the undersigned,swear that the above statements are true and correct and 1 agree to notify the City Clerk if there is any change in the
above information.
I further understand that issuance of a Local Business Tax Receipt by the City Clerk in no way relieves me of the responsibility of
compliance with all prov s ons of the Code
++of Ordinances pertaining toconductinga business in the City of Atlantic Beach.
Title
7516r—e
�nn� r�s I� I�r7 ►�,
PRINT NAME Date
No person,firm or corporation shall engage in or manage any trade,business,profession,or occupation in Atlantic Beach without
first obtaining a Local Business Tax Receipt.Application and/or payment does not constitute approval or issuance of a receipt.
******************************************************************************************************
Section 4(For Office Use Only)
$25.00-Zoning Fee Paid on _ $75.00-Building Fee Paid on Business Tax Receipt#
LFULL YR L._HALF YR Business Tax Amount $ Code#&Classification
J Fictitious Name Reg. Corporation Reg. F1 State Reg/Cert/Lic# Ll Health Cert#
OTHER Requires Commission Approval !'-]Yes []No Approved/denied by Commission on
ZONING APPROVED BY DATE
BUILDING DEPT APPROVED BY �� •►� (•:o•� _ DATE
FIRE DEPT APPROVED BY DATE
c-.. C�:cs►L DATE
CITY CLERK APPROVED BY _ DATE
Last Business Use: Last Business Name: