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Permit Doggy Dining Al's Pizza 2012 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 �Dj Application Number . . . . . 12-00100032 Date 9/25/12 Property Address . . . . . . 363 ATLANTIC BLVD Tenant nbr, name . . . . . . 363 1 ALIS PIZZA Application type description DOGIFRIENDLY DINING APPLICATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ----------------------------------------------------------------------------- Application desc DOG FRIENDLY RESTAURANT ---------------------------------------- ------------------------------------ Owner Contractor ------------------------ ------------------------ SHOPPES OF NORSHORE LLC OWNER P.O. BOX 330108 ATLANTIC BEACH FL 32233 ----------------------------------------------------------------------------- Permit . . . . . . DOGS ALLOWED TUTDR FD SERV ARA Additional desc . . DOGGY DINING RENEWAL Permit Fee . . . . 125 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/25/13 --------------------------------------- ------------------------------------- Special Notes and Comments NEED PROOF OF LIABILITY INSURANCE PERMIT MUST BE RENEWED EVERY YEAR AND IS VALID UNTIL OCTOBER 1 . QUATER Y INSPECTIONS WILL BE DONE. --------------------------------------- ------------------------------------ Fee summary Charged aid Credited Due ----------------- ---------- --- ------- ---------- ---------- Permit Fee Total 125 . 00 125 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 125 . 00 125 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 0 0 Cik of;V(anlic &aC4 DOG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordimn4 e No.95-10-102) 1. FOOD SERVICE ESTABLISHMENT INFORMATION: NAME OF ESTABLISHMENTAI's Pizza FL DFIR# SEA-2611595 PROPERTY ADDRESS 363-1 Atlantic Blvd#1 AB BTR #BTR-1 2-00003412 CITY,STATE,ZIP Atlantic Beach,FL 32233 PHONE# (904)249-0002 EMAIL ADDRESS eevaull4@gmail.com FAX #(904)249-0470 2. APPLICANT INFORMATION: NAME OF APPLICANT Al Mansur Submittal COMPANY Al's Pizza Inc Requirements MAILING ADDRESS 303 Atlantic Blvd lRenewal Fee:$125.00 rx- CITY,STATE,ZIP Atlantic Beach,FIL 32233 Completed Permit rx— EMAIL ADDRESS al@alspizza.com Application Form PHONE# (904)249-0002 FAX # (901)249-0470 Proof of Ownership rx- 3. PROPERTY OWNER INFORMATION,IF DIFFERENT FROM APPLICANT: Authorized Agent rx- Affidavits(ifapplicable) NAME OF OWNER Michael Junk roof of Insurance rx- COMPANY E� MAILING ADDRESS 915 13th St N Diagram of Designated rx- Outdoor Dining Area CITY,STATE,ZIP Jacksonville Beach,FIL 32250 EMAIL ADDRESS Completed Pre-Application Consultation Form PHONE# (904)246-2542 FAX # 4. PROOF OF OWNERSHIP: 6. DAYS &HOURS DOGS ALLOWED: Please check the box of the applicable document and attach a copy to thisform. FX- DUVAL COUNTY PROPERTY RECORD CARD I- DUVAL COUNTY RECORDED DEED FX- SUN 10arn-11prn rx- MON 10arn-I'llorn 5. PROOF OF INSURANCE: Please provide an original certificate of insurance,or have your agentfax a copy,fyour certificate providing [R TUE 1 Oam-11 prn commercial general liability insurance in the amount of five hundred thousam I dollars ($500,000.00) per rX- VV E D 1 Oarn- 11 pm occurrence and one million dollars ($1,000,000.00) aggregate. 7he policy sh ill not have exclusions jbr animal bites. All insurance shall be from companies duly authorized to do busi iess in the State of Florida. rX- THU 10arn-11prn 7hirty(30)days written notice must be given to the City of Atlantic Beach Risk Management prior to any JR FRI 1 Oarn-12arn cancellation or reduction in policy coverage. 7he City of Atlantic Beach Risk�anagement (800 Seminole Road,Atlantic Beach,FL 32233)must be listed as a certificate holder. rX- SAT 1 Oarn-12am I HAVE READ THE INFORMATION IN THIS APPLICATION AND UNDER PENALTIES OF PERJURY, I DECLARE THAT THE FACTS STATED I?i I THIS APPLICATION ARE TRUE. //I( 144'�— �� 11.4A V6 q K— qlz--rll 2 AMUCANTSSIGNATU" APPUCANTS PR]NTED NAME DATE DOG-v2011.01 B I V d Above is it diagrain of the outside patio orAl's Piz��a located at -3)U3 AtIanti,; Blvd. Atlantic Beach, FL. 32233. This is the proposed area for a designated outdoor dining area t1or dogs to be allowed. The patio is open on three sides. One of two entrances into Al's Pizza is located in the center of the patio. Just to the left of the entrance on the patio we will display notification that the patio is pet frie idly and the approved required rules for this to be a pet friendly dining are, 'rhere are 6 '�ables with 4 chairs cacti on the patio Cto,01flan6c 00 OG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordinar ce No.95-10-102) 1. FOOD SERVICE ESTABLISHMENT INFORMATION: NAME OF ESTABLISHMENTAI's Pizza FL DHR# SEA-2611595 PROPERTY ADDRESS 363-1 Atlantic Blvd#1 AB BTR #BTR-1 2-00003412 CITY,STATE,ZIP Atlantic Beach,FL 32233 PHONE# (904)249-0002 EMAIL ADDRESS eevau114@gmail.com FAX #(904)249-0470 2. APPLICANT INFORMATION: NAME OF APPLICANT Al Mansur Submittal COMPANY Al's Pizza Inc Requirements MAILING ADDRESS 303 Atlantic Blvd lRenewal Fee—si-25 oo--� rx– CITY,STATE,ZIP Atlantic Beach,FL 32233 Completed Permit EMAIL ADDRESS al@alspizza.com Application Form rx– PHONE# (904)249-0002 FAX # (904)249-0470 Proof of Ownership R 3. PROPERTY OWNER INFORMATION,IF DIFFERENT FROM APPLICANT: Authorized Agent rx– Affidavits(if applicable) NAME OF OWNER Michael Junk COMPANY roof of Insurance FX- MAILING ADDRESS 915 13th St N Diagram of Designated CITY,STATE,ZIP Jacksonville Beach,FL 32250 Outdoor Dining Area IR EMAIL ADDRESS Completed Pre-Application Consultation Form rx– PHONE# (904)246-2542 FAX # 4. PROOF OF OWNERSHIP: 6. DAYS &HOURS Please check the box of the applicable document and attach a copy to thisform. DOGS ALLOWED: rX– DUVAL COUNTY PROPERTY RECORD CARD r– DUVAL COUN rY RECORDED DEED jX– SUN 10arn-11prn 5. PROOF OF INSURANCE: rX— MON 10am-11prn Please provide an original certificate of insurance,or have your agentfax a copy(f your certificate providing FX- TUE 1 Oarn-11 prn commercial general liability insurance in the amount of five hundred thousanc dollars ($500,000.00) per fX– WED 1 Oarn-11 prn occurrence and one million dollars ($1,000,000.00) aggregate. 7he policy shall not have exclusions for animal bites. All insurance shall beftom companies duly authorized to do business in the State of Florida. [X– THU 1 Oarn-I I pm 'Airty(30)days written notice must be given to the City of Atlantic Beach RisA Management prior to any JX– FRI I Oarn-12arn cancellation or reduction in policy coverage. 7he City of Atlantic Beach Risk Management(800 Seminole Road,Atlantic Beach,FL 32233)must be listed as a certificate holder. f)7 SAT 1 Oarn-12arn I HAVE READ THE INFORMATION IN THIS APPLICATION AND UNDER PENALTIES OF PERJURY, I DECLARE THAT THE FACTS STATED INTHIS APPLICATION ARE TRUE. /"Z( /e,,— . �� Y/z-r1l 2 AMUCANTSSIGNATLW APPLICANT'S PRI qTM NAME DATE DOG–v2011.01 Ci�of0flan6c &ack DOG FRIENDLY RESTAURANT PERMIT APPLICATION (Per Ordirmr ice No.95-10-102) DIAGRAM OF DESIGNATED DOG-FRIEN DLY OUTDOOR SEATING AREA In the space below,provide a diagram (to scale)of the designated outdoor shating area showing thefollowing: • Boundaries of the designated dog-ftiendly outdoor seating area 1 vith dimensions, to scale • Boundaries of any non-designated outdoor seating area with dii 7ensions, to scale • Number and placement of tables, chairs and restaurant equipmant • Location of entryways to and exitsfrorn all designated and non-designated outdoor areas • Location of allfences andlor barriers • Location of property lines and public rights-of-way, including s fdewalks, curbs, common pathways and public improvements, such as benches,fire hydrants,etc NAME OF ESTABLISHMENTAI's Pizza FL DHR# SEA-2611595 E a F Al's Pizza, 303 Atlantic Blvd 3 I t ao e0wo (I O*bP* o o 0 C 815" `1 1 47' 0 a S t B I V d Above is I diagrain of the outside patio of Al's Pizvh located at 30 Atlanik,; Blvd, Atlantic Beach, FL 32233, This is the proposed ar(a for a designated outdoor dining area for dogs to be allowed. The patio is open on three sides, One of two entrances into Al's Pizza is located in the center ofthe patio. Just .0 the left of tile entrance on the patio we wil I display notification that the patio Is pet friendly and the approved required rules for this to be a pet friendly dining are. There are 6 tables with 4 chairs each on the patio Inspected&Approved by: APPEICAM 1STZYT-R --TTD-QTR 3RD QTK_ 4TH QTR APPROVAL INSPECTION INSPECTION INSPECTION INSPECTION DOG_v2011.01