Permit 2405 Mayport Rd Pet Caravan 2011 Feb 08 11 01:36p PET CARAVAN 3865302117 p.1
1-2011
City of Attantic Beach • 809 Seminole Road •Atlaatk Beach,Florida 32233-5445
Pbone (904)247-000 • Fax (904)247.5645 - http:1hvww.coeb.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 Beata 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 propmty or
business operations, the use of outdoor tents, service or 000king 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
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DATE.
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N'BUSCNESS AND APPIJCANT NAME :�� ( ,� �`:� 'L4 i- ^ h l-t�; ,
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MAILDvG ADDRESS: k�� �c...� t- ;„ ia
ADDRESS AND LOCATION WHERE EVENT WILL TAKE PLACE (If dilfereot from mailing address.)
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REQUESTED DATES)FOR TEMPORARY EVENT
THE BELOW SIGNATURE ACKNOWLEDGES THAT THE PROPERTY OWNER AND/OR THE
COMPANY CONDUCTING SUCH TEMPORARY EVENT ASSUMES ALL L ABELny AND
RESPONSIBH.JTY FOR SUCH EVENT.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT.
Signature of property owner or authorised agent
SIGNATURE � t its 1--�.c.-(.,�PRM 14 AMM- �_([L].f Zf
CONTACT INFORMATION OF PERSON SlJ83Er TEVG THIS REGISTRATION FORM aesanrrl
NAME l : r C : '2'� `-- - V".
MAMINGADDRESS -x=�^7 �Jri T,Or{��� _;<< �3C . t • %.0 c�
PHONE �5 _ Z FAX '_)Cr_,Cc -5, — j ' Ic XAJ L
Please provide all information as requested on the attached.pages.
Feb 08 11 01,36p PET CARAVAN 3865302117 p.2
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1. Wbat type ofalcohol will be served and how? Beer? Wine? Other? Served inside? Outside?
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.)
3. Identify the event sponsor and provide approe contact person in case of any emergency.
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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.
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3. Has the business consulted with neighboring businesses to obtain their approvals?
6. Will them be outdoor music? Will there be amplified outdoor music? What Lours?
7. Will there be a live band? What hours?
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S.How many people are expected to attend this event?
9.How will crowd control be managed if there is an overflow crowd?
10. specific special events are planned? (...such as bobbing for apples;ring toss;dunking booths;wet
t-shirts;bikini contests;all malelfemale"review')
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11.How will parking be located and managed? Include site plan showing parking areas to be used for this
event t, 19 U 6-4 'c-'< ti:. '-f f`)iL jtE.iti-•C- 7
12.How will security needs be provided;particularly with respect to prohibiting minors from being served.
(See following question.) Will o ffduty police or private security be used?Who is the contact person on-
site if blems arise? (Must be approved by City of Atlantic Beach Police Department.
13.Ho are they going to assure that all people consu bW alcohol are old enough? Wrist bands? Door
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14,Are any tents to be erected on the property`s (Tent registration form required.)
15.Will there be any outdoor heating or cooking'? If so,address how any by-products and refuse will be
handled, including greaseloillrefuse. How will any extra trash collection and disposal needs, during and
after the event;be addressed? /
16.Will there be any extension of electricity into the parking areas, outdoor areas or any yards?
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17. Speci temporary events cannot negatively impact traffic flows,patticularly in any adjacent residential
areas,or close or block any public street or right-of-way Please address.
18.Address how fixe code requirements and aooess for emergency vehicle be monitored and maintained stall
times during the Special event.
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19.Are there! ow&to be any fires or fireworks?
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20.Other thin service ani-sls,are there going to be any animals allowed as part of this special event?
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21.Is this a first time event or a continuation of an annual event?
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22.Were they complaints or problems at prior everts of this nature?
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23.What additional signage be used? (Such as for advertising, restroonv%alcohol consumption`s(City
Sign regulations
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 ::�2r 1
PRMTKAME �✓'�'un! � !
EVENT APPROVED:
REQUEST DENIED:
SIGNED: DATE:
Depw meet of Public Safety
SIGNED: DAI'E.
Jim Hanson,City Manager
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