1179 ATL BENNETTS LANDSCAPES BTRCITY OF ATLANTIC BEACH
800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
LOCAL BUSINESS TAX APPLICATION
Section I
APPLICATION TYPE: NNew Business Transfer of Ownership
Transfer to New Location: Previous Location �(�C
BUSINESS NAME: �11-r�lpt? S` �-�d�o��5+`'.1=e-"r`�` °,�•a'�`�Yl
LOCATION ADDRESS: I � 9CA' �c- -� V 1NAAayy, ' C ._r 4'C. 3 33
MAILING ADDRESS::
BUSINESS PHONE"1 33 FAX: CELL:
EMAIL ADDRESS: %-e" 3 O Cabs- ` '
BUSINESS ENTITY IDENTIFICATION NUMBER: Federal Employer I.D. Number - �"t p -1
or
Social Security Number -
PLEASE EXPLAIN THE NATURE OF THE
\ ► z , no, V a✓
SQUARE FOOTAGE OF BUSINESS PREMISES: t 3,00 Cyr
(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
Alcoho1: Yes ( 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:
rt#R!►irtt44liiiiiff4ii#i4i#ii#iirtii#####tttiiif ifii##f4#iti4i##4iilift#i#tii#t!i#t#tt##itt##!t►##+##i#
Section 2 n "�
APPLICANT/ LOCAL MANAGER/ PRIINCIPAL OFFICER: �QYi1P5 vim! 9 Y�
HOME ADDRESS: I b3 G NI -00 e� f ST �D hrS a ciS
HOME PHONE: a S R 3 a CELL: '83�-
DATE OF BIRTHLo - -+-b DRIVERS LICENSE # (Please attach a copy.) 165313 (. Li 3 — ::)-o a0) --�
EMAIL ADDRESS: Cb I ( d)cbn- ' . r`� -�" �,t? Ire P Co --r nE-
STATE LICENSE/CERTIFICATION/REGISTRATION N (if applicable, attach copy):
i►tit#ttttflttf+Ri#ftlRt#iR###Rii#t►#i+►f+ittt+fli##it#i#RtRif t4itt4Rt♦+i►4tiittt►it R#44#iRfti#iffitk
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 compliance with all provisions of the Code of Ordinances pertaining to conducting a business in the
City of Atlantic Beach. /
PRINT NAME: CoTITLE:
SIGNATURE 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.