155 LEVY RD BTR APP CITY OF ATLANTIC BEACH
800 SEMOINOII-gUOINESS TAX ATLANTIC 32233
APPLICATION
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Section 1
Business UTransfer Ownership ®Transfer New Location:Previous location
APPLICATION FOR ❑ New
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BUSINESS NAME C
Clea u F(- 3 a 33
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LOCATION ADDRESS 7j C (� 33
MAILING ADDRESS 1'0 S A S L,&N'TK 13t_V P 3 4 2 p ''� -6;F
BUSINESS PHONE 8"0 y q6 q- 13c.y FAX
8PF - y3f--931J CELL y��!- y��
EMAIL ADDRESS cy R..f S (f QW a FtZA�.C3 F1<1-'A-t<<1-' -t<
NATURE OF THE BUSINESS(Please Be Specific) M b`J U
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E FOOTAGE OF BUSINESS PREMISES c,areas)
SQUAR
(Include both buildings and outside areas used in conjunction Nt>z�e business,but not patron parkin„
NUMBER&TYPE OF VENDING MACHINES(if any)
Section Z CHP-6 S Y'^1 C N C� + ?A ori C`
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER J
HOME ADDRESS L i C'GE;e,.�FQttfs? Q2 > � 1 �t
HOME PHONE 4 6 y 9 8 3 -01&9 SSM or Fed Employer ID# �� _/,Z3 -0 attach copy)
DATE OF BIRTH y
DRIVER'S LICENSE# Sd U C e
STATE LICENSE/CERTIFICATION/REGISTRATION#(if applicable,attach copy) N>
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 int e
above information.
I further understan hat issuance of a Local Urd nances pes Tax Receipt rtain ng to eonduct ne City lerk in noway relieves me of the g a business in the City of Atlantic Beachbility of
compliance with rovisions of the Code of IDf�T
C E�l�plL.�3• �
+ Title
Signa '
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PRINT NAME
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 do* notconstituteMPP o a o�issuance�oreceipt.
Fee Paid on Business Tax Receipt
Section 4(For Office Use Onlyl $100.00-Zoning/Building
❑FULL YR ❑HALF YR Business Tax Amount $____
Code#&Classification
❑ Fictitious Name Reg. ❑ Corporation Reg. ❑ State Reg/Cert/Lic#
El Health Cert#
Requires Commission Approval Yes No Approved/denied by Commission on_._._.____---
OTHER DATE
ZONING APPROVED BY
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� ��A DATE_ �j �
BUILDING DEPT APPROVED BY
`� DATE
FIRE DEPT APPROVED BY DATE
CITY CLERK APPROVED BY
Last Business Use: Last Business Name: