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Permit 323 Atlantic Boulevard CITY OF r~~'~tKtic S~ac~ - ~~y~ 716 OCEAN BOULEVARD P. O. BOX 26 ATLANTIC BEACH, FLORIDA 32233 TELEPHONE (904) 249-2396 February 17, 1983 Ms. Jacqueline Gross-Whaley The Coffee Garden 323 Atlantic Blvd. Atlantic Beach, FL 32233 RE: "Use by Exception" Permit - 323 Atlantic Blvd. On Premise Consumption of Beer and Wine Dear Ms. Gross-Whaley: On February 14, 1983, the City Commission of the City of Atlantic Beach reviewed your application for a "Use by Exception" permit. The City Commission granted approval for the permit. With the "Use by Exception" permit, you are authorized to use the above referenced property for on premise consumption of beer and wine. Sincerely, A. William Moss v-/ City Manager AWM/ls cc: Use by Exception File City Clerk Building Record File ... ~" t CITY OF ~'ea.~i - ~l'ozcc~ 7160CEAN BOULEVARD P. O. BOX 26 ATLANTIC BEACH, FLORIDA 32233 TELEPHONE (904) 249-2395 February 14, 1983 REPORT OF ADVISORY PLANNING BOARD "Use by Exception" Application - Jacqueline Gross-Whaley - Lot 8, Block 1, Atlantic Beach - Coffee Garden On February 8, 1983, the Advisory Planning Board considered "Use. by Excep- tion" application submitted by Jacqueline Gross-Whaley for the Coffee Garden situated on Lot 8, Block 1, Atlantic Beach. The property is in a Commercial General zoning District. The Land Development Code provides that on-premise consumption of liquor, beer and wine is permissible as a "Use by Exception." Considerable discussion ensued regarding the lack of customer parking for the establishment. The Advisory Planning Board recommended approval of the "Use by Exception" permit with the condition that the City Commission consider the Advisory Planning Board's concern for the potential parking problem and Lack of customer parking. Furthermore, the Advisory Planning Board recommended that the City Commission consider placing restrictions or conditions on the "Use by Exceptions" which may be appropriate for problems associated with lack of customer parking. Respectfully, .~ ~}-j A. William Moss City Manager AWM: j Z -i''• r ' 'USE BY }:XCEPTI O1J~ A)'1'1.) CATION .: DATE Fl LED: (- oZ~ - ~3 LOG N0. . NAriE b ADDRESS OF OWNER O~ TENANT~IN POSSESSION OF PREMISES: ~ C~ ~ inn r~ C~ Imo i , R ~T . .At ~A~ ~ rC~ ~~ Ac ~ ~--~~r Q A 3?~~ PHONE woRK: a~~O- ~~~~ HOME: ~'t(p-O8~.3 AN ADEQUATE LEGAL DESCRIPTION OF THE PREMISES AS TO WHICH THE USE BY EXCEPTION IS REQllESTED: 1 C~~c ~.a~ . A DESCRIPTION OF THE USE BY EXCEPTION DESIRED, 47HICH SHALL SPECIFICALLY AND PARTICULARLY DESCRIBE THE TYPE, CHARACTER AND EXTENT OF THE PROPOSED USE BY EXCEPTION: TO 3 e.~ A 4~t~ -~ ~.~. S~ A `3 ~..~ rz. -~- t.v i iU ~, ~-. (C'~ ~ s ~ (2 CoP> i o ~~om_~t~ Hl ~H~(~___ ~~R ~~ S O~ m~A~S . F~ LZ ~ ou ~ t1-~ t ~ ' ~ -t- t~ Ocx~'" R tJo ~J - ~ ~ !Z 5 h ~ ~~ P t ~'~ ~ `~ ~ RUC r~ ~ THE REASON FOR REQUESTING THE USE BY EXCEPTION: ~(~ ~ S(~ ~ es O~ C~ICc ~ ~ S ~e©P c. ~ oR ~ ~ 2 u ~ ~ rn Pao ~ D ~- ~.~. !a CAA r ~ ~~ L~~ inn r~Lou~D ~ (~`Tt,A ~T~ C 3~ ~ ~ c ~ oSTo fZ U~ t~ A ReC~A t rn F O ~ ~ ~,AT / ,~ ~ +~ IUD l~ 1 1 - ~~~ ~~u ec-c~u s ~ iu ~ ~ ~o-r~s PRESENT ZONING: C G _ ~ S .'AT OF APPLIC ~ OR APPL T'S AUTHORIZED A NT O ATTORNEY. AGENT OR ATTORNEY, INCLUDE LETTER OF APPLICANT/Ok'NER OR TENANT TO THAT EFFECT. --------------------------------------------------------------------------------------------- REVIEW GUIDELINES 1. Ingress and egress to property and proposed structures thereon with particular reference to atuomotive and pedestrian safet and convenience, traffic floe and control and access, in case of fire or catastrophe. ,Q ~ y?~jyyr,(~c.p,~~ ~ 1 _ w • /~ _ ---r-~ 11.G L ^v! L ~.._-~_ .. _ _ ---'------_ _- ~.~ ~• • , Refuse and service areas, with particular reference to t}~e items in (1) end (2) above. It )~ /rx~ts ~ ~ ~_Y_~.~.~-~Z_J~.~~ ~ Utilities, with reference to locations, availability and compatibility. Screening and buffering with reference to type, dimensions and character. _ Gc..~..C~, ~ C3~~ Signs, if any, and proposed exterior lighting, with reference to glare, traffic safety, economic effects and compatibility and harmony with properties in the district. Required yards and other open spaces. (~/~~`~~~_ y2_v l1 ~ ~ ~~~ - ~1 ~-~ ~ ~ GCeneral compantibility with adja~ce~nt properties and other property in the district. l 1 ~ ,nn /4~n M ,~ n l ~F' ..1 In s ~ r . ~,r r_ ~!'1 /~ l~ ., ~ !1 ~ e n !1 n ~ l6 . " Any con~on ~ restri t ns or li~ation~he use of suc}t premises., , ~ _ f jvisory Planning Board's Report and Recor~endations: ~ 3 ~~,,,~ a~/~ . ~- ~ ~ 5 I y I t ur r t_! 1K 1 llN '! ~~ -~ ~~.~ ~Bx ~02.~----i 'SENT OF BUS N SS RE011LAT ON DEPART I E 1 Rev, to-ao DIVISION OF ALCOHOLIC BEVER!~CES AND TOBACCO ,~J ~~Q APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE a~~-~~a3 ~-aye/-~~8c~ I tISTRUCT 1 ONS: I. This application must be typed and filed in duplicate. As part of our service the Division of Alcoholic Beverages and Tobacco will be happy to assist in the preparation and typing of this application. 2. All questions-must be answered. If a question does not apply so indicate by N/A. 3. This application is taken under oath. Persons filing false applications or information may be prosecuted and their application denied. TYPE OF APPLICATION Check Appropriate Box(es) x x(x ~ ~ ~fJew ( ) New - Additional ( ) ( ) One Day Permit (For ) ( ) ( ) Temporary Transfer ( ) ( ) Transfer ( ) ( ) Change of Business Name ( ) ( ) Change of Location Increase in Series Decrease in Series Change in Series ~' Change of Officers Correction Other FOR ANY TRANSFER OR CHANGE APPLICATION ONLY: 1. For Transfer of License No. 2. From _ 3. Business Name Current Series III FOR ALL APPLICATIONS 1. Full Name of Applicant(s) Jac-,~~,~1;nP 7.aTP~k; (;rocs ___ 2. Business Name ~ The ~-~ {{PP 6a *'d Pn 3. Location of Business_32~ At7 nt; 1vd. . A Tan ; Roc-h yzva~~ STREET N0. MUNICIPALITY COUNTY ZIPCODE 4. Mai 1 i ng Address Same As Above IF DIFFERENT FROM LOCATION OF BUSINESS ZIPCODE 5. Type of License Desired (Series 2Cpp )* 6. If applicant is a corporation or a limited partnership list the charter number issued by the Florida Department of State_ xA _ __ ~. List below the names of all those connected, directly or indirectly. in the business for which the license is sought: (This includes Partner(s), Spouse. Director(s), Stockholder(s), Chief Executive. Limited and General Partner(s). Corporation(s), or any form of entity which is connected with this business). NAME OFFICE (IF CORPORATION) OR NATURE OF INTEREST OTHER TITLE IF ANY INCLUDING STOCK $ A. Jacaveline Z. Gross 8. C. D. E. F. G. t ;.' B. Nave any of tt~e above nar,~:d persons or cntltlcs ever held a beverage license? U„ C, Nas a license covering the place described in this application or any other place in which any of the above named persons or entitles were at the time interested ever been revoked by the Director? N o D. Are any of the persons or business entities now, or have they been in the past, interested in, affiliated or connected with, directly or indirectly, including through stock ownership or otherwise, any .corporation, partnership or individual engaged in, directly or indirectly, the manufacturing, rectifying, distilling, distributing, importing, exporting, or selling at retail, any alcoholic beverage in the State of Florida or any other State? - _____ ND If the answer is "Yes" to any of the questions asked give full particulars SALES TAX 1. Do you acknowledge your statutory responsibility to obtain a.prop saes tax account number before operating a business under the license~:you ar r~~~ / seeking? YES Initials: ~1/ RIGHT OF OCCUPANCY 1. Does applicant have a legal right of occupancy to the premises sought to b licensed? YES Explain (Incluce the landlords name and address if applicable- -? VI HEALTH APPROVAL - TO BE COMPLETED BY TFiE ST~Tc/COUl~TY HEALTH AUTHORITIES ONLY: ! nspect ion of thi s establ i shzznt was rti.4e on ~ J, ~ ~;;., and i t was found that the sanitary facilities of the e~tablishroant Comply (~ Do Not Comply with the minimum requirnents under regulations of the Florida State Sanitary Code, as promulgated under Chapter 193eb, Czneral Laws of FTorida, .` Sanitarian-County Health DepartR~nt V11 ZONING APPROVAL 1. Is location within the 1irr~its of an incorporated municipality? YES 2. This premises is applying for a 2C0P type license. This would authorize sales of aTcohoT is beverages as fol lo~1s• Beer and wine for consumption on premises with package sales 3. IMPS PORTION IS TO BE COn°LETED BY THE LOCAL ZOl11tJG AUTHORITIES ONLY: ,~ The above location does ~omply ~~ith local zoning ordinance for the sale of alcoholic beverages as stated a~ove_ ^_, TTr ~•.,ove location does not co:~:?ly with local zoning ordinance for the ~~~t~ of a1coT-oiic 5everages as statee above. _ ~ <, , ~_.,,~_,,,_ County ~"• i:.~ •'t ~=:;~~.1t~ tCs .;'(C~~t. ,R [lU2 :.Lr ~ JLIC BEVERAGE LICENSES. 1 {;J~ ~~_ {:tf Title: Date ~ • f' ~ AFF I DAVI T OF APPLICANT OR F3UYER P.6 I, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swear or affirm that 1 am duly authorized to make the above and foregoing application and, as such I hereby swear or affirm that the above and foregoing or attached sketch or blueprint is substantially a true and correct representation of the premises to be licensed and agree that the place of business, if licensed, may be inspected and searched during business hours or at any time business is being conducted on the premises without a search warrant by Officers of the Division of Alcoholic Beverages and Tobacco, the Sheriff, his Deputies, and Police Officers for purposes of determining compliance with the beverage law. I further agree that in the event said premises are altered or any additions are made thereto, such alterations or added portions to the said licensed premises may be inspected in the same manner and by the same officers as is agreed to in the case of the original premises that may be licensed. "I swear under oath or affirmation under penalty of perjury as provided for in Florida Statutes 837.06 and 559.791 that the foregoing information is true to the best of my knowledge, and that no other person, persons, firm or corporation, except as indicated herein, has an interest in the alcoholic beverage license for which these statements are made" - further agree that the above and foregoing sketch will become and is.a~~part of the application for a license. (Applicant STATE OF FLORIDA County of 1 hereby certify that before me this -acqueline Z. Gross and after being 11AME OF APPLICANT day of 19 personally appeared sworn says that the signature above is his, that he has read all of the above, that the answers to the questions appearing herein are true and correct. - I~litness my hand and seal the day and Year first above appearing in the State and County aforesaid. Notary Pu~l i on Expires AFFIDAVIT OF SELLER (, hereby swear or affirm that I am duly authorized to Hake this affidavit and do hereby onsent, on my behalf or on behalf of the seller, to the above transfer, and represent to th Division of Alcoholic beverages and Tobacco that the license which is being transferred is s shown in the application and that a sale in good Faith has been rode to the within appli ant of the business for which the foregoing transfer ~f Ticense is sought. - SELLER, OR AUTHORIZED CORPORA710N OFFICER iTATE OF FLORIDA :ounty of ~. ~ LICENSED PHEHISES P.3 retch Drawn By Date Sketch Verified By Date ~- J~~t DEPARTMENT OF BUILD1NCi CITY OF ATIANTiC BEACH --_ ~- P£F~MT'T INFQR~fATI©N ----._--_ __ ____,_ L.f]GATIpN Y>~Ft~RMATIQH -_.:~.~a, F~rmit Nt:mb~r: 3877' Addre~>~: 3faS ATLAt~tTTC BCIULEYA D ~~ Per~a~.t Typ~z EL.ECTRICE3L ATLANTIC H1vACH. FLC~R , A :322. Cla~~~ ~# Wr~rkC: ALT£RATI©N _______.___ .LEGAL L?ESCRIPTI©H -~-_---~___ Cc~n;~tr. Typ~z MASONRYlSfiIGH Lc~t : BZock : S~Gti~t~~n Prapc~:~a~d Us~~: RETAIL. ,STORE Townerhip: RNG: 4 O Q~~lliri~~ i tl Coti~e: O Bubdivis~ie:n E~tim~t~d Yelue: ~I~.00 I~prrav. Cast: ~O.Od Tc:t~l f:taecs: ~~~. £30 At~c:ut~~t Pir~,d tl,'3, ~; ~~5. 80 _____4_ _~ OWN~g' ~WF©RMATTON _,: __ ~ ~- _----- A,PPLI"C/~'1'TilN FEES __w__ 1«1>R~~; .EiNf3PA'~~ "©~ ~C~RTN SHC3RE ~ PERMIT X45. l3Q _ Addr~~» : S~3 !t~'~ANTIC HOLILEYARC7, #~ ~IA'T.EF~ XMi'A~`~' FEE #O. L1C: :' A7LAHTIG SE~1CH, FLQRII~A 32;2 S SEW£H ,~MFt-C"t FEt;: >~Q: ,.. Pli~~: {~04d~4~~-StaL't3. WA'~ER llETtaR ~C1. t3t9 RAaL1N~ GAS--H. R. S. ffiO. QO __.~__.._ CO1~iTf~ACT[]E~ -~HFdRMATt.E3N --___ _ RADt]fJ GAa - 5J ~O. ~O Id~me: ~~ILC.'I'H©MPSflN ELECT.t~ZC C17, NG '+VATER TAB' ~Q.00 Addr~s>~: PO 84}~ g03~8 OENER TAP ~Q.OQ ATLANTIC BEACH, fL 37233 HXt3R~iULIC .SHARE ~O. f3Cl Lia~~s~s Ef~4t:3C)Jy6"76 Type: ~ RE-INSFEC'f PEE #Cl. C)O SEG. H II~PAC~T FEE ~U ` ~' ~~ ~ ,~.~ w~~~ .Y,~ _ .- `~~ ~ a ,, a~ ~.~,_~ ~sT~`E~ .. .... _ ,~.~_.~~_ NOTES: NOTICE -- ALICONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORf POURING I PERMIT VO10 SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL; RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED (N PUBLIC 5PACE,AND MUST BE CLEAREDUP AND HAlltED AWAY BY EITHER CONTRACTOR OR OWNER. `~fA1LURE TO Ct~MPLY WITH THE. MECHANICS' LIfN LAW CAN RESULT IN THE PRt1PERTY,QIIVNER ~AY1NG TWI~E'FOR BUILDINGdMPROVEMENTS." ~~~ ~:~~ ..ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART QF THIS PERMIT ANb SUBJ~~ TO REVOCATI~I~OR 1faOLATtON OF APPLICA$lE PROVtS1pNS 01= LAW. ~~ ~~`''~ : S ATLANTi BEACH gUILDIfVG DEPgFtTMENT By: CITY OF fQ~le^.~ic l~eaClt - ~l o~tu~Pa Offica of Building Offi~Tal REGIUEST FOR INSPECTION Date ~ ~~ '~~+~ Time ~; ~ S A Received M ~3 ~ 3 64~f1a ~ ~'c- Vc~ Permit No. `-' ~~ v District No. Job Address i..ocaf ity Owner's ~~ l ll~ -~~f/~ /I / ~Oi? ~`l eG'~J f j~l~'JL11~ Name i Contractor . BUILDING CONCRETE ELECTRICAL PLUMBING MECHANICAL Framing ^ Footing ^ Raugh Wiring ^ Rough ^ Air. Gond. 8~ ^ Re Roofing ^ Slab ^ Temp Pole ^ Top Out ^ beating lintel ^ Fire Place ^ Pre Fab READY FOR INSPECTIO N A.M. Mon. T ues. ed. Thurs. W Frlday P. M. py~' t ~ p 3 A.M. Inspection Made o P.M. ll tl Fi ~'" Inspector na nspec on Certificate of Occupancy Date S ifs CI T'Y OF ATLANI'I C BEACH INSPECl'IONS BUILDING PERMIT N0. , __ ELECTRICAL PERMIT N9;`~ PLUMBING PERMIT P10. MECHANICAL PERMIT N0. JOB AllDRESS_ __ ~~!~'.__ _._ ~~•" `-~!.__ _ ` ______ CONTRACTOR ~ ..6~1`- ~-"~-- _ - ___~~ -_ OWNER.-- -- ---------------- -------- - - ins e ted approve-disaproved FOUNDATION FOOTING __ _ ___!^ SLAB - _ PLUMBING (R) OUT __ > SEWER TE MP POLE ELECTRICAL (R) _ ELECTRICAL (F) ~~ ____ FRAMI N'Q" , •' PLUMBING {F) LINTEL/BEAM COLUMN STEEL S'ri00T GRADES LOT CLEARING ___ _ FINAL INSPECTION -_ ___ ..MECHANICAL HEAT/AC FIRE PLACE ~~ reinspected -..~-~y JEA r~teakt~c ~eacls - 716 OCEAN BOULEVARD P. O. BOX 26 ATLANTIC BEACH, FLORIDA 32233 TELEPHONE 1904} 249-2386 February 14, 1983 REPORT OF ADVISORY PLANNING BOARD "Use by Exception" Application - Jacqueline Gross-Whaley - Lot 8, Block 1, Atlantic Beach - Coffee Garden On February 8, 1983, the Advisory Planning Board considered "Use. by Excep- tion" application submitted by Jacqueline Gross-Whaley for the .Coffee Garden situated on Lot 8, Block 1, Atlantic Beach. The property is in a Commercial General zoning District. The Land Development Code provides that on-premise consumption of liquor, beer and wine is permissible as a "Use by Exception." Considerable discussion ensued regarding the lack of customer parking for the establishment. The Advisory Planning Board recommended approval of the "Use by Exception" permit with the condition that the City Commission consider the Advisory Planning Board's concern for the potential parking problem and lack of customer parking. Furthermore, the Advisory Planning Board recommended that the City Commission consider placing restrictions or conditions on the "Use by Exceptions" which may be appropriate for problems associated with lack of customer parking. Respectfully, `L/ ` ~~ ~~ A. William Moss City Manager AWM:~1 k ~\ 'USE BY F,XCEI'TI ONE Al'I'LI CATI ON DATE FILED: ` _ 02~ - 3 _ LOG N0. NAME b ADDRESS OF OWNER 0 TENANT IN POSSESSION OF PREMISES: PHONE o~~.~~_t_~ ss - w~A l - WoRx: a~~ - ~5to ~- o~ C~ ~ Im ~ (~ ~ o I ~ ~ ~T . HOME : ~~ l~ - 8$x-3 .P ~" C,A iJ ~ (C~ ~ L° A C ~ ~ (.021 ~~ZZ ~ ~o <'' ATE LEGAL DESCRIPTION OF THE PREMISES AS TO WHICH THE USE BY EXCEPTION IS RE VESTED: A DESCRIPTION OF THE USE BY EXCEPTION DESIRED, [,TI-IICH SHALL SPECIFICALLY AND PARTICULARLY DESCRIBE THE TYPE, CHARACTER AND EXTENT OF THE PROPOSED USE BY EXCEPTION: -r"o ~ P A~L~ -ro u s~ A 3~,~.2 ~- w l ~u~ ~. I t~,u s 'E~ _ ~2 _~o P~_ - ~__- _-~ ~ o rn_o__-t~_-__t~l _~_1-~ ~. (Z. t5_C~_C~ S _---0 F m ~ r~ l 5_ ~~ ~ ,~ ~'AaKs-t~ ~nc~n~S. ~1~AI S. `' (1~'c~C~\ A ~~~.2. Co_Si_S °+~ S(~ ~ A2tf ~ 5 ~~- ~k I~Tf~ ~S1 _ ~--~SS 1 S ~ ~-~O ~~~o ~>r~- W~ ~~ ~ fi (-~ ~cA~- R ~.~o tJ - `~ ~ (Z ~ h ~ ~ ~ e i ~~ (v~ ~ ~ tiC r~ ~ THE REASON FOR REQUESTING THE USE BY EXCEPTION: bU R., S(~ ~ C S o~ 'm~ ~ ` S `fie ~c. oRt~~2 ~~~rnP~o ED ~~ ~_~ c ~ ~ ~ ~ 1 W (~ R t ~ l Y~ f~ c~ ~ q ~ ~ ~y~n P T ~t oSTo (Z ~ . ~ ~~~ ~11~~ ~ PRESENT ZONING: J~}0 W A RCC~A ~ rn E 0 \ AIU~ fra ~- ~ . ~~,. A R~ A 1 S .'ATUR OF APPLIC OR APPL C T'S AUTHORIZED A NT 0 ATTORNEY. AGENT OR ATTORNEY, INCLUDE LETTER OF APPLICANT/OWNER OR TENANT TO THAT EFFECT. --------------------------------------------------------------------------------------------- REVIEW GUIDELINES 1. Ingress and egress to property and proposed structures thereon with particular reference to atuomotive and pedestrian safet and convenience, traffic flow and control and access. in case of fire or catastrophe. ~ Q,~Q ~ ~^C/YYL-C-~.C_J ~ ~(,CiCJ ~~ln/.Y- /' - - c n~~ , n n-,~ ~ /14., , ~, n , it , .-~n n-,. , ~ /7 ~ , PACE 2 ' OF 2 'USL•' liY l:\Cl:PT1 ON' AI'I'Ll CAT1 ON 3. Refuse and service areas, with particular reference to the items in (1) and (2) above. ~« , . ~. 4. Utilities, with reference to locations, availability and compatibility. ~~ C~~x..c~ ~ ct~ - ~ c 5. Screening and buffering) with reference to type, dimensions and character. i ~ ., . 6. Signs, if any, and proposed exterior lighting, with reference to glare, traffic safety, economic effects and compatibility and harmony with properties in the district. /~ ~ _ ~ . _ 7. Required yards and other open spaces. _ ~ ~ $. General compatibility with adjacent properties and other property in the district. /~ ,., 9." Any co~ .~ _ ..,_ , premises. ~`~- - - •~ ~ - ~.. gyn. ~.~-~,< <. ~ -.- ~..~.~..~ ~.r ---(~---------------U--------------------------------------- -------------------------------- Advisory Planning Board's Report and Recommendations: _~3~~ c~-~, . n ~ e~ /n ~e_ •. s 1 v ~ rb'~~,3 ~~-,,~~a~~-~~`~~~Sl.~llt ur rL!1K1llH ~l~,~J~G .~~.. ~r~. ~~ ~tiBx 70Q,----~' DEPART;~ENT OF BUSINESS REGULATION Rev. 10-HO Z`'-~ DIVISIOPJ OF ALCOHOLIC BEVER!~GES AND TOBACCO -~~~~ C,c~Q APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE INSTRUCTIONS: 1. This application must be typed and filed in duplicate. As part of our service . the pivision of Alcoholic Beverages and Tobacco will be happy to assist in the preparation and typing of this application. 2. All questions must be answered. tf a question does not apply so indicate by N/A. 3. This application is taken under oath. Persons filing false applications or information may be prosecuted and their application denied. 1 TYPE OF APPLICATION .~ Check Appropriate Box(es) xx(x~3cRidew ( ) Increase in Series ( ) New - Additional ( ) Decrease in Series .' ( ) One Day Permit (For ) ( ) Change in Series .' ( ) Temporary Transfer ( ) Change of Officers ( ) Transfer ( ) Correction ______ ( ) Change of Business Name - ( ) Other ~~ ( ) Change of Location -! ____ II FOR ANY TRANSFER OR CHANGE APPLICATION ONLY: 1. For Transfer of License No. Current Series 2. From _ V~` 3. Business Name III FOR ALL APPLICATIONS 1. Full Name of Applicant(s) 2. Business Name 3. Location of Business ~~_gj-awn slvd Atlan~;~ B~~ch D~..va7 ?Z233.. STREET N0. MUNICIPALITY COUNTY ZIPCODE 4. Mai 1 i ng Addres5_ Same As Above IF DIFFERENT FROM LOCATION OF BUSINESS ZIPCODE 5. Type of License Desired (Series 2~op )* 6. If applicant is a corporation or a limited partnership list the charter number issued by the Florida Department of State__ NA _ ' 7. list below the names of all those connected, directly or indirectly, in the business for which the license is sought: (This includes Partner(s). Spouse. Director(s), Stockholder(s). Chief Executive. Limited and General Partner(s). Corporation(s) or any form of entity which is connected with this business). NAME OFFICE (IF CORPORATION) OR NATURE OF INTEREST OTHER TITLE IF ANY. INCLUDING STOCK $ A. Jacqueline Z. Gross B. C. D. E. F. ~ . . g. Have any of the above named persons or entitles ever held a beverage • license? nrn . C. Nas a license covering the place described in this application or any other place in which any of the above named persons or entities were at the time interested ever begin revoked by the Director? 1yO D. Are an of the y persons or business entities now, or have they been in the past, interested in, affiliated or connected with, directly or indirectly, including throuyh stock ownership or otherwise, any .corporation, partnership or individual engaged in, directly or indirectly, the manufacturing, rectifying, distilling, distributing, importing, exporting, or selling at retail, any alcoholic beverage in the State of Florida or any other State? - _~ NO If the answer is "Yes" to any of the questions asked give full particulars SALES TAX 1. Do you acknowledge your statutory responsibility to obtain a.prop saes tax account number before operating a business unsier the license you ar r~=~Y seeking? YES Initials: / V RIGHT OF OCCUPANCY 1. Does applicant have a legal right of occupancy to the premises sought toy licensed? YES Explain (Incluce the landlords name and address if aaplicable - VI HEALTH APPROVAL - TO BE COMPLETED BY TtiE ST:;Tc/COUI~TY HEALTH AUTHORITIES ONLY: Inspect ion of thi s establ i shT-ent was rr~de on /~ ~ ~;;~, and i t was found that the sanitary facilities of the establishT nt_ Comply (~ Do Not Comply with the minimum requirments under regulations of the Florida State Sanitary Code, as promulgated under Chapter 19je6, General Laws of Florida, .` Sanitarian-County Health Department VII ZONING APPROVAL 1. is location within the iirr~its of an incorporated municipality? YES 2. Thls premises is applying fora 2COP type license. This would authorize sales of alcoholic beverages as fol lows• Beer and wine for consumption on premises with package sales ~. 1H15 POR710N IS TO BE COMPLETED BY 7HE LOCAL ZONING AUTHORITIES ONLY: ~_` T?.e above location does comply ~~ith Tecal zoning ordinance for the sale v! alcoholic beverages as stated above. .....__. Tr.r ~'.~ove location does not co~r:ply with Tocal zoning ordinance for the _-_..•al~ at alcoTrol is beve- rages as stated above. ~:~ -- Title: _. <, , ~---..~-..~..,_. amount ' • ---------_'- Y ~.~~ i:~ is t~a~l~i~;• r~ . LUS A~ rn~~~ ~~ o~„ .__ Date f x AFFIDAVIT OF APPLICANT OR BUYER P.4 1, the undersigned individual, or if a corporation for itself, its officers and directors, hereby swear or affirm that I am duly authorized to make the above and foregoing application and, as such I hereby swear or affirm that the above and foregoing or attached sketch or blueprint is substantially a true and correct representation of the premises to be licensed and agree that the place of business, if licensed, may be inspected and searched during business hours or at any time business is being conducted on the premises without a search warrant by Officers of the Division of Alcoholic Beverages and Tobacco, the Sheriff, hls Deputies, and Police Officers for purposes of determining compliance with the beverage law. further agree that in the event said premises are altered or any additions are made thereto, such alterations or added portions to the said licensed premises may be inspected in the same manner and by the same officers as is agreed to in the case of the original premises that may be licensed. ' "I swear under oath or affirmation under penalty of perjury as provided for in Florida Statutes 837.06 and 559.791 that the foregoing information is true to the best of my knowledge, and that no other person, persons, firm or corporation, except as indicated herein, has an interest in the alcoholic beverage license for which these statements are made" • further agree that the above and foregoing sketch will become and is.a~part of the application fora license. (Applicant) STATE OF FLORIDA County of (hereby certify that before me this day of 19 personally appeared Jacqueline z. Gross and after being sworn says that the signature above is his, I~AME OF APPLICANT • that he has read all of the above, that the answers to the questions appearing herein are true and correct. • Witness my hand and seal the day and year first above appearing in the State and County aforesaid. Notary Pu~l i i~ on Expires XI AFFIDAVIT OF SELLER (, hereby swear or affirm that I am duly authorized to make this affidavit and do hereby onsent, on my behalf or on behalf of the seller, to the above transfer, and represent to th Division of Alcoholic Beverages and Tobacco that the license which is being transferred is s shown in the application and that a sate in good faith has been made to the within appli ant of the business for which the foregoing transfer of iicense is sought. OR AUTHORIZED CORPORATION OFFIC STATE OF FLORIDA CENSED f}ZEHISES P•3 Sketch Drawn By _ Date Sketch Verified By Date CITY OF ATL.~NTIC BEACH, FLORIDA -Apps by APPLICATION FOR ELECTRCAt PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 19 n ~ IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN fOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED: PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN'ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. , NAME_ ~' __ADDRESS• 31:3 ~i?~f~1~^-;~ -~r.~-s/ RFD BOX BLDG. SIZE BETWEEN:. RES. ( 1 APT. ( 1 COMM.1~ PUBLIC l 1 INDUS. l 1 `NEW ( 1 OLD 1 1 REW. ( 1 ADDITION { - TRAILER 1 1 TEMP. (;1 SIGNS ( ) SD. fT. SERVICE: NEW ( ) INCREASE 1 1 REPAIR 1 ) FEE CONDUCTOR SIZE AMPS COPPER ALUM. TCH OR BREAKER AMPS E;XIbT. SERV. SIZE 2- AMPS PH ' ~! PH W W VOLT ~~~OLT RAC WAY 7 !r d~ RACEWAY FEEDERS.. NO. S12E NO. SIZE NO. SIZE. LIGHTING OUTLETS CONCEALEDL OPEN TOTAL .RECEPTACLES CONCEALEQ OPEN TOTAL O.30 AMPS..' ~ 31.100 AMPS. SWITCHES INCANDESCENT ', FiUORESCENT & M. V. FIXED 0.100 AMPS. OVER APr~tANCES BELL TRANS F. AIR CONDITIONING' H.P. RATING COMP. MOTOR H.P. RA~TiNG OTHER MOTORS AMPS CEIL HEAL KW-HEAT MOTORS 0 H 1 .P. VOLTAGE PHS NO. OVER 1 N.P. VOLTAGE PHS MISCELLANEOUS " TRANSFORMERS: UNDER 600 V. OVER 600 V. CITY C?~ ATI.~'~NT~C BEACH, FLtJR1aA i .tea by APPLICATION `.' FDR E4ECTRICAI. PERMIT ~'' '~~~ i TO THE.CHIEF ELECTRICAL iNSPEGTOR: DANE: August 30 ~g '$2 iMPOt3TANT NOTICE:. fN CO.NSID R T E A ION OF PERMIT GIVEN Fa~R f)OfNG THE WORK AS DESCRIBED 1N THE FOLLOWING, WE HEREBy''AGREf TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH AREA .PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS CODES AND CITY OF ATLANTIC BEACH ORDINANCES. :McClure Electric Co McClure ELECTRICAL FIRM: MASTER ~LEC~TRICIAN SIGNATURE _ .ihURN,_, EYIIA, 1~N, NpME_ Jackie Whaley ADDRE~S; 323 Atlantic Boulevard ~RFD,_,._...,,.BOX BLDG. SIZE ~- BETWEEN• RES. ( 1 APT. ( I COMM. (~ PUBLIC~1 1 INDUS. ('I NEW t I OLD Ixl REW. ( I ADDitION ! ) TRAILER f ) TEMP. l } SIGNS ( ) SQ. FT. SERVICE: NEW I 1 INCREASE ( I ~ REPAIR lXl FEE CQNDUCTOR SIZE AMP COPPER ALUM. SWITCH OR BREAKER AMPS PH W VOLT R AY EXIST. SERV. SIZE '100 AMPS 1 PH 3 W 230 VOLT 1 " RACEWAY t=f?f=DfR$ NO. _'. SI2~i: NO. i~171~_ tom: SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES '~ CONCEALED OPEN TOTAL O-SO AMP8. 91.100 AMPS. SWItCHEB INCANDESCENT FLUORESCENT & M. V. ~ ~ FIXED 0.100 AMP S. OVER wPP~.l,atvcES BELL TRANS F. AIR CONDITIONING H.P. RATING COMP. MOTOR H.P. RATING OTHER MOTORS AMPS CEIL HEAT: KW-HEAT MOTORS U H -I .P. VOLTAGE PHS NO. OVER 1 H.P. VOLTAGE PHS MISCELLANEOUS ft lac ru m ter n . T SF ~ ORMERS: RAN UNDER. 600 V. OVER 600 V. ~~ ~~ CfTY OF ATl.AINTIC BEA-~H, FL~JRIDA ~' LECTRICA4 PERMlT .~~ APPLICATION fOR E _ ~ t~ ~~ NSPECTOR: DIE: TO THE CHIEF ELECTRICAL i' IMPORTANT N07ICE: ~; IN CONSIDERATION OF PERMIT GIVEN FO DOING THE WORK AS DESCRt PLANS AND SPECI~CATtONSE HEREBY AGREE TO PERFORM SAID WORK IN A CORDANCE WITH THE ATTACHED WHICH ARf A PART HEREOF, AND IN ACCt3RDA CE WITH THE ELEGTRIGAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. I'i ~` E ECTRICAL FORM: TER EIECTRI 1 i AT NAME ~' -~ ~ ~/ ~~ _ ADORE ~SS: .2 ~ f RFD BOX BLDG. SIZE M d~_~BETWEEN: RES. ( 1 APT. ( } COMM~ PUBLIC~~ { } INDUS. l 1 NEW ( } OLD { 1 REW. { } ADDITION ( } TRAILER ( } TEMP. { } ~j SIGNS t 1 $Q. FT. FEE $EAVICE: NEW ( ! INCREASE ( ) REPAIR ( } CONDUCTOR SIZE AMPS COPPER ALUM. SWITCH OR BREAKER AMPS PH W VOLT RACEWAY 2~~z~ EX1STr8-ERV. SIZE AMPS PH W VOLT RACEWAY FEEDERS N0. SIZE NO. SIZE NO. ~ SIZE lIt3HTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL SWITCHES O.30 AMPS, 91.100 AMPS. INCANDESCENT FLUORESCENT & M. V. FI ED 0.100 AMPS. OVER X APPLIANCES BELL TRANS F. AIR CONDITIONING H.P. RATING COMP. MOTOR H.P. RATING OTHER MOTORS AMPS CELL HEAT: KW-HEAT NR?TORS Q H -1 .P. VOLTAGE PHS NO. DYER 1 H.P. VOLTAGE PHS MISCELLANEOUS TRANSFORMERS: UNDER 600 V. OVER 600 V. DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH, FLORIDA PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date $~~ 19 $~ Valuation $ MECHANICAL Fee $ 41.00 This permit not valid until above fee has been paid to City Treasurer, and is subject to revocation for violation of applicable provisions of law. This is to certify that service Engineers Inc. PERMIT N0.~4 3 ~, ~t~ •OU T a 1. uI~Cli T :t~~e.~ •i~[FC~C u,~., has permission to ~,~ ,Ii~i~TAT.T. Af'. gS PFR UT ATJ~ Classification COMMERCIAL Zone CG Owned by GAFF. YnC;iii2T Lot Block S/D House No. 2Z~j ~3i- ATLANTIC BLVD. According to approved plans which are part of this permit NOTICE-ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS ,, AFTER DATE OF ISSUE ~--'--~ ~-T 0 Building material, rubbish and debris -zi from this work must not be placed in public space, and must be cleared = up end hauled away by either con- "tractor CirW~~vner. .' . r' . ~ .;, , t{~ r ,. .. , .,,. _. `,~ r Building Official. U EON Y I NUMBER + DATE +.~,~' CONTRACTOR PLUMBING '. ELECTRICAL ,w SEWER WATER ' .+a. CITY OF f_r1,A'~TIC EEr'~C1', FLORIDA ~.PP~~IC~Tl~~! ~-~~P. ~~~I-~~t~{C/~-L ~~RP~~T (~1F~RTAhT-l,:.p(~c*snt to c~rr~plob ~!I i4ems in satF~rs 1, tl, il(, and (V. t• pn ~V "' ~• [:dr oF_. ~ (tntrrs~tti«q Strasttj ~pCA:T10'J (t;'ortt,, So„4t~, Estt, w.tt) r r ~~ (/.dd~cu) ~ , t- "~ ~ ~ r Lot No 6tnck Nc+______ c.,.,}~--d;~:s:an .!J«}stis !Sist• rr~~ion of lot i( '<-cs t''.sn Fa:"u lot-Attaci~ tr;a1 dsuripf:oe prr dvn4 in dupl;uh i( nocsu-sryj -_ _ ` ~~V ~tt aT j'~~fu~~ ~.~~:"{ril+~(~.~ !"{t~ K - ~~ f~rG:t'','7 CC~tr+.ti.+-ff f'Gr~S I~ --- A. use aF [vlw~Nc RtSICcMT1AL -. ^ Orvr (lm.ly EntK rumiar^ of ro-.+++t 3, ^ Trsnsiant, Mrtel, motrl, ~minQ LrOU11 -"- Ent-r numisrr of uni1~. ___._ 4. ^ OtF,rr rrsidrnfirl _____ NON-P.ESICi:NT1,11 5. ^ Jv-.U~.~^nant, r+craaf;onel t3. ^ C}urc}+, Oi~rf rr~~r~iOUl T. ^ Induslnrl t. [] 6sreyr, sAr.icr s`.siian 9. ^ Nos~i!e1, insiitu4anrl 10. ^ Officr, 6anE, prcfcssionsl i 1. ^ Uhisty 13. ~Stors. ns.-::mile O trw 14. ^ OTHGR--Sty-ECtFY ~_ p, -~t.ECKA.wlCAL E~UIPi,.{'.--~tT TO CE IASs.~L.~p (Pro.idr completr fist of com~7on-r.ts on brit of t}tis faun) 23. ^ Furnsca: ^ $Fsece ^ Rs.crsed O Gntrel D r:;.Car 24. ~r Conditioning: ^ Dons ~Crnirel 25. ~ duct $ya!rm: 1.4etsr;el V ~M'~rTw7+if~r.asL_._~_._~ /.Qsaimu~* upacitp ~/ ~~ c.f.m. 2S. ^ Rrfriysraiion 27. ^ CoOlinq ta.•rr: CepaC~i'y g,,o.m. Il. ^ f'n sFrin4lrrs- Nur*,brr of -.c-a dt___~- -.-_ ~._ 24. ^ Et:.sfor ^ 6.fsnti(1 ^ Es. ~.lsto•~ (nvr'.Qer) 30. ^ Ge:alier pur:^•-i («vm`car) 3T. ^ LPV conisine.!~_ (nc:-sberj 33. ^ Ur.fi-:d Fs.-cssurs ~eurl 34. ^ ?oi!crs ((l. (7~ ~.Al iht; OR!u.4IlON A. Tsp. cf t~.. e!ing 4,.r1: ~~ (~ F',.ctric '15. ^ -r;vctr (i«di-i~+w1, ~lr~rct;on, r+~!,J"'O.1t 1RT!i}~itl'Xl. Mt~•' !~. ^ PYSt;c (~4ri1, Stlir O+ lout ~FS'r.+wwtj G tt.,TUrt: ox woRK 17. ^ kr~ ~a~~n9 I[, ^ Exis!ing rnrr'1.f'i'Rg. ' It. ^ Rt =-s=rr*:~~nf of szisf;«q ytfo•w ?0. [~/1Nw i^.strC:stron (}{-o.sryrsta<e G";,~;:+ar~y i:sbs.%.adj 21. ^ E=t-¢;%n of ac~-on to esnfin4 ry;!rrn. E T'Ct~ OAF t`Ji?~r'i~ 37. ^ 1+/t.cd (rime 38. }1z.:.n7 and <r ~1 34. ^ I:rinror:rd cnncroh 4t). ~ :!ryc hr r6l Ltifl 41. ^ O'f+er Trls srAC~ (oR o~ usE oss1,Y R xr.r r4s f`rrmii A~~.-ad by Dafr Pa-}°rsit Fs~s H. !S CTHR G.^.kSTi:'JCT10N ErErKG D~^-tE ON THIS HJtLDilfG GR Sl7E9 DEPARTMENT OF BUILDING C[TY OF ATLANTIC BEACH, FLORIDA PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date 9!1! is~ ,~ Valuation $ Fee ~ 4 . O O PERMIT NO, ~ ~ ~ ~ I This permit not valid anal abpve tee has been paid to City Treonnr, and is subject to ravoeetion Eor violation of applicable provisions of Lw. This is to certify that JQSelYne GOUT laouen has permission to build t W O S j. Q n S --- I Clat3sificatio*~ if ffi E Y~'1f R~ 1~ erne Owned by-1~tlantic Beach I301dincl Co Lot Block ';/D House No 323 Atlantic_ Blvd. According to approved plans which are part of this permit NOTICE-ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIR MONTHS ~ AFTER DATE OF ISSUE O Building material, rubbish and debris ~ from this work mnst not be placed in public space, snd mast be cleared np and hauled away by either contractor or owner. R. C, Vage1 Baildint of8cfal. FOR OFFICE PERMIT DATE CONTRACTOR U$E ONLY NUMBER PLUMBING ELECTRICAL (EWER _. _ ~-'~ ,.„.~, ~ , cs~ ~ ~ ~~~ ~ +MlfMie, BU#LDfNG PERMIT APPLtCATiON JURISDICTION OF APPIICANT70 COMPLETE SECTfON A ONLY SECTION A JOB ADDRESS b i L LOT NO. BLK. TRACT ~ OESC R. (a SEE AT 2 OWNER MAIL ADDRESS ZIP PHONE CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 3 ARCHITECT OR DESIGNER MAIL ADDRESS' PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS PHONE -LICENSE NO. CLASS OF WORK: Q NEW, ^ADDITIONALTERATION ..REPAIRMOVE REMOVE 7 BUlLD1NG CHARACTERISTICS C.PR(NCiPAL TYPE OF FRAME G. DIMENSIONS A. PROPOSED USE GROUP ;,.",o,SONRY NUMBER OFSTORIES RESIDENTIAL NON-RESIDENTIAL --WOOD FRAME TOTAL SQUARE FEET OF FLOOR STRUCTURAL STEEL AREA,RLC FLOORS. BASED ON ]ONE FAMILY DWELLING ^ASSEMBLY ~REINFORCEDCONCRETE EXTERIORDlMENSIONS -OTHER -SPECIFY TOTAL LAND AREA, SO. FT. ~TiNO OR MORE FAMILY DWELLING; ~ BUSINESS (OFFICE} NO OF UNITS: H,NUMBER OF OFF-STREET . . EDUCATIONAL D.TYPE OF HEATING FUEL. PAR KING SPACES. [],HOTEL, MOTEL DORMITORY ENCLOSED , , NO.OF UNITS ~] FACTORY - INDUSTRIAL -GAS: OUTDOORS _.,.- _OI L QGARAGE ]HAZARDOUS ._ELECTRICFTY I. RESIDENTIAL BUILDINGS ONLY -COAL CARPORT. ^ INSTITUTFONAL BOTHER -SPECIFY NUMBER OF BEDROOMS OTHER -.SPECIFY ~ MERCANTILE E.TYPE OF SEWAGE DISPOSAL NUMBER OF BATHROOMS STORAGE FULL PUBLIC OR PRIVATE COM PANY ff OTHER -SPECIFY -PRIVATE (SEPTIC TANK, ETC.) ~ PARTIAL F.TYPE OF WATER SUPPLY. ~PUBLiC OR PRIVATE COM PANY -PRIVATE (WELL, CISTERN) 8. NON-RESIDENTIAL-DESCRIBE (N DETAIL THE PROPOSED USE OF THE BUILDING. ., . - :.~ :- ,. 8 VALUATION OF WORK A. BUILDING $ - :`• *,° B. PLUMBING $ C. MECHANICAL $ D. ELECTRICAL $ E. -0THER $ F. TOTAL VALUATION 1 HEREBY CERTIFY THAT 1 HAVE READ"AND EXAMINED THIS APPLICATION AND KNOW THE 'SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS. TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED< HEREON OR NOT, THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE AUTHQRITY TO VIOLATE ,OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAT- iNG CONSTRUCTION OR TWE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF CONTRACTOR OR AUTHQRtZED AGENT (DATE) ; SIGNATURE OF OWNER (IF OWNER BUILDER)... (DATEI BUILDING PERMIT AppL,I;CATION t~ JURISDICTION OF P (CANT TO COMPLETE SECTION A ONLY SECTION A APL ~ ~` JOB ADDRESS ~ ~ ~ ~~ L q~ /~ ~ (71 ~~ ~ ~ ~ i"~ ~ ~ ~ ( ~~ `~ `. L '~ DESCR. LOT NO. BLK. TRACT ''~~ (^SEEATTACHEDSHEA~ OWNER MAIL ADDRESS. ZIP PHONE 2 ~~~, to 1 '~ '~ ~ ~ ,... CONTRACTOR MAIL ADDRESS PHONE LIC NS NO. , 3 ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. 4 ~ ENGINEER MAIL ADDRESS PHONE LICENSE NO. 5 6 CLASS OF WORK; NEW ADDITION ALTERATION REPAIR MOVE REMOVE 7 BUfLDING CHARACTERISTICS C.PRINCIPAL TYPE OF FRAME G.DIMENSIONS A. PROPOSED USE GROUP ~ soNRY NUMBER OF STORIES RESIDENTIAL NON-RESIDENTIAL ~-V~'vOD FRAME TOTALSOUARE FEET OF FLOOR ^STRUCTURAL STEEL AREA,ALL FLOORS. BASED ON ^ONE FAMILY DWELLING ^ASSEMBLY ~REINFORCEDCONCRETE EXTERIOR DIMENSIONS -OTHER -SPECIFY TOTAL LAND AREA,SO. FT, []TWO OR MORE FAMILY DWELLING; ~ BUSINESS (OFFICE) NO. OF UNITS EDUCATIONAL H.NUMBER OF OFF-STREET D.TYPE OF HEATING FUEL PARKING SPACES ^ HOTEL, MOTEL, DORMITORY, ENCLOSED NO. OF UNITS ^ FACTORY -INDUSTRIAL -GAS OUTDOORS _OI l []GARAGE ~ HAZARDOUS _ELECTRICITY I. RESIDENTIAL BUILDINGS ONLY -COAL CARPORT ~ INSTITUTIONAL ,OTHER -SPECIFY NUMBER OF BEDROOMS OTHER -SPECIFY ~ MERCANTILE E,TYPE OF SEWAGE DISPOSAL NUMBER OF BATHROOMS, []STORAGE FULL _PUBLIC OR PRIVATE COMPANY ~ OTHER -SPECIFY -PRIVATE (SEPTIC TANK, ETC.1 PARTIAL v F,TYPE OF WATER SUPPLY Sr1, -PUBLIC OR PRIVATE COMPANY -PRIVATE (WE LL,CISTERN) B. NON-RESIDENTIAL -DESCRIBE IN DETPIL THE PROPOSED USE OF THE BUILDING. ,.. ~.1 .... • L ~ ~. ~ S 8 VALUATION OF WORK ~ ~ /®+~. "' B. PLUMBING$ A. BUILDING$ ~,~~ «` C. MECHANICAL $ D. ELECTRICAL $ E. OTHER $ F. TOTAL VALUATION / j /yam 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS ~ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ! ""~ r ~ ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT,. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAT- ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. " RACTO OR THORIZED AG T ( E) SIGN URE OF CO ~ ~ r SIGNATURE OF O ER (IF ER BUILDER) (DATE) E