HIBBETT SPORTS Received
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 FEB z ] 2015
LOCAL BUSINESS TAX APPLICATION
Section 1
Office of City Clerk
APPLICATION FOR SkwBusiness ❑Transfer Ownership []Transfer New Location:Previous location
BUSINESS NAME 1v
LOCATION ADDRESS �� aoh -
MAILING ADDRESS - 1-I
:700I1��L `t
-
h, �� 'C'II��)aJ/0�- (`pyn—V1 m,1 SIT Allo , hL ��'2-��
BUSINESS PHONEQr-5 'L FAX CELL
NATURE OF THE BUSINESS(Please Be Specific)
4, r
SQUARE FOOTAGE OF BUSINESS PREMISES S -
(Include both buildings and outside areas used in conjunction with the business,but not patron parking areas)
NUMBER&TYPE OF VENDING MACHINES(if any) �Jh
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Section 2
APPLICANT/LOCAL MANAGER/PRINCIPPAL OFFICER
HOME ADDRESS -29-5I P(- U56". sn �11e- bifztnlh N �(.
HOME PHONE -' SS#or Fed Employer ID �_ 1
DATE OF BIRTH ;4, 1'159 DRIVER'S LICENSE# r/0 3 w�(og �*0 (Attach copy)
STATE LICENSE/CE TIFICATION/REGISTRATION#(if applicable,attach copy)
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Section 3
I,the undersigned,swear that the above statements are true and correct and I 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
co is ce ith all provisions of the Code of Ordinances pertaining to conducting a business in the City of Atlantic Beach.
ftcC" p 11
gnature0 Title
moat&
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.
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,Section 4(For Office Use Only)
$25.00-Zoning Fee Paid on $75.00-Building Fee Paid on Business Tax Receipt#
❑FULL YR ❑HALF YR Business Tax Amount $ Code#&Classification
❑Fictitious Name Reg. C Corporation Reg. ❑State Reg/Cert/Lic# ❑Health Cert#
OTHER Requires Commission Approval ❑Yes ❑No Approved/denied by Commission on
ZONING APPROVED BY DATE
BUILDING DEPT APPROVED BY •4 DATE
FIRE DEPT APPROVED BY —57J o`3— �� � DATE
CITY CLERK APPROVED BY DATE
Last Business Use: Last Business Name:
JACKSONVILLE FIRE AND RESCUE
DEPARTMENT
FIRE PREVENTION DIVISION '' s
FIRE SAFETY INSPECTION BILLING FORM J�
STATE OF FLORIDA STATUTE 633.081(1)
CITY OF JACKSONVILLE ORDINANCE 2004- 1003
Business Name: Date: L —1 — Is
Inspection Type: 1 vy g a Occupant Use:
Inspection Address: _S9iq
�{1 c- Occupant Load::
City, State: �-�{ �� lr--L, Zip code: 3�Z'3
Email Address: Business Telephone: 2-4
Billing Information:
Billing Address: Billing Telephone:
City, State: Zip code:
Inspection Information:
Square Ft: d4 4)&S
TIN: (FE_IN/SSNI Number: j Ol 90(0 ?
Citation or Warning Issued? Yes Q No Q
Scheduled Return:
Citation/Warning number(s):
Inspection Notes:
Fire Extinguisher:. S Alarm:
Sprinkler/Riser:
Hood: Hood Cleaning: Hydrant..
This occupancy meets min' re fety requirements at this time. Yes �� No Q.
I acknowledge rec ipt of this inspection form. Inspector
/' Initial
Recipient Name: "�' G' tai' Inspector Name: MIC
E L D 1 Pl1= R -
Recipient Title: Inspector Contact Number:
515 N.Julia Street Jacksonville, Florida 32202 (904)630-0445 FAX(904)630-4203 Rev. 03/2014
S==59 i�
ATLANTIC BEACH
J
PERMIT RECEIPT
PERMIT DESCRIPTION: #997 HIBBETT SPORTS#1294 OL FEE
PERMIT NUMBER: 15-OCCU-1124
ADDRESS: 1021 ATLANTIC BLVD MAIN
OWNER:
FEES DUE:
Occupancy Fee $100.00
Totals:
$100.00