97 LEVY RD OL APP CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
LOCAL BUSINESS TAX APPLICATION
Section 1
APPLICATION TYPE: New Business ❑Transfer of Ownership
Transfer to New Location:Previous Location
BUSINESS NAME: CC Island Group LLC DBA 13,I. Lo Z'ECA
LOCATION ADDRESS: 97 Levy rd. units 160,173-175 Atlantic Beach, Florida, 32233 a'1 Liv0`l8�
MAILING ADDRESS: 97 Levy rd. Atlantic Beach, Florida, 32233ltk`Al
BUSINESS PHONE: 9046396810 FAX: CELL: ()uE5DfU*N
EMAIL ADDRESS:biltechindust(es@gmail.com
BUSINESS ENTITY IDENTIFICATION NUMBER: Federal Employer I.D.Number 47-1142476
or
Social Security Number
PLEASE EXPLAIN THE NATURE OF THE BUSINESS:
ceramic coatings of fi AgAgmg
SQUARE FOOTAGE OF BUSINESS PREMISES: 360
(Include both buildings and outside areas used in conjunction with the business,but not patron parking areas.)
Will the following be served? Food: Yes No
Alcohol: Yes No If yes, Select One: ICOP 2COP 4COP
If restaurant,will dogs be allowed? Yes No
Will you have any vending machines? Yes No If yes, please provide quantity and type below:
Section 2
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER. Ivan W„
HOME ADDRESS: 750 Paradise Lane
HOME PHONE: 9045368802
DATE OF BIRTH: 01 NOV 1964 0 / (Please attach a copy.)
EMAIL ADDRESS: ivan_washkow@
STATE LICENSE/CERTIFICATION/RE(
Section 3
I,the undersigned,swear that the above st J <2% the City Clerk if there is
any change in the above information.
I further understand that issuance of a Loc /-� �L"' way relieves me of the
responsibility of compliance with all provisio v 6 D Ming a business in the
City of Atlantic Beach.
Iv b as kow Jr ,,caner
PRINT NAME: -L
SIGNATURE DATE 4-23-2015
No person, firm or corp tion shallVax
or manage any trade, business, profession, or occupation in Atlantic Beach
without first obtaining a Local Busineipt. Application and/or payment does not constitute approval or issuance of
a receipt.