155 LEVY A & B BEACH FRAMES LLC CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
LOCAL BUSINESS TAX APPLICATION I,)P,1 A-1Lb"�l�
Section 1
APPLICATION FOR [I New Business ❑Transfer Ownership Transfer New Location:Previous location
C1��1
BUSINESS NAME F"MC' L�c�� ' ' � A�,�;jc. g C%-C lV FC 3 J a 33
LOCATION ADDRESS (� l-t`v y �D '5
MAILING ADDRESS �Ul S AiLAr TJfi , GLQO P342 TIC
Ate, r rRI=�CU rL Z 233
�ac>-�IG9- 13(-,,4-4 FAX 8 P@ - 431-93ld CELL z,c'/- 983 -,0;F1
BUSINESS PHONE
EMAIL ADDRESS C u(Z 1 S �' 6 C-,.e u FF m T
NATURE OF THE BUSINESS(Please Be Specific)
SQUARE FOOTAGE OF BUSINESS PREMISES
(Include both buildings and outside areas used in conjunction wity the business,but not patron parking areas)
NUMBER&TYPE OF VENDING MACHINES(if any)
N F
Section 2 C H k I S4 tom'I C!J C,C -rA rJ n1 G
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER r�Tl C
HOME ADDRESS �u11 oft) �`� I L �, � ��
HOME PHONE 4611 –4 g SS#or Fed Employer ID#
DATE OF BIRTH y DRIVER'S LICENSE# ~ l U 4 ~C _�`�3 _D (Attach copy)
(� �
STATE LICENSE/CERTIFICATION/REGISTRATION# if applicable,attach copy) NI —
�s:k:t:#x:k$;%l::F+:;:F:gx+kKB::g:;e�;e:k�.#*:Kd:#%k#:#f.<%F#ek*%kicseek%k*:%#%t#8:#>;::F:!:ek�ek*KM%k##•k,
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 Business Tax Receipt by the City Clerk in no way relieves me of the responsibility of
compliance with orovisions of the Code of Ordinances pertaining to conducting a business in the City of Atlantic Beach.
Title
Signa
PRINT NAME Da
tb
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.
Fee Paid on Business Tax Receipt
Section 4(For Office Use On $100.00-Zoning/Building
❑FULL YR ❑HALF YR Business Tax Amount $_ __— Code#&Classification
❑ Fictitious Name Reg. ❑ Corporation Reg. ❑ State Reg/Cert/Lic#
❑Health Cert#
OTHER Requires Commission Approval Yes No Approved/denied by Commission on
DATE
ZONING APPROVED BY
• �.C.•.�!r'f�►� DATE ���t ••►
BUILDING DEPT APPROVED BY � _
DATE
FIRE DEPT APPROVED BY
DATE
CITY CLERK APPROVED BY
Last Business Use: Last Business Name:
Walker, Jennifer
From: Groff, James [JGroff@coi.net]
Sent: Tuesday, July 21, 2015 8:35 AM
To: Walker, Jennifer
Subject: RE: BTR Inspection for 155 Levy Rd
Inspected and passed by Inspector Dipierri 6/17/2015.
egpf, j7441*es IV/0// CFPE
Jacksonville Fire & Rescue Department
Fire Plans Review
515 Julia Street
Jacksonville, FL 32202
(904)—255-8320 Office
(904)-718-7452 Cell
Email JGroff(a)coi.net
fnK
4�'hcn f=kric3.�flc-�u�.
http//www coi net/departments/planning-and-development/building-inspection-division.aspx
"Your never a great man when you have more mind than heart."
From: Walker, Jennifer [mailtoJwalker(a>coab.us]
Sent: Tuesday, July 21, 2015 8:22 AM
To: Groff, James
Subject: BTR Inspection for 155 Levy Rd
Good morning Capt. Groff,
Per our phone conversation, please send the BTR approval for Beach Frames LLC at 155 Levy Rd. Suite A& B.
Thank you, have a great day,
JeV%'V"U WcOzer
Administrative Assistant
Building Department
City of Atlantic Beach
904-247-5826
i