363 ATLANTIC BLVD #5 - APPLICATION /MOVE 511�\1 5 e)91) 914/114- iv 9/4/,V
CaP'11 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
LOCAL BUSINESS TAX APPLICATION
535
Section 1 2� /37VD
APPLICATION FOR ❑New Business DTransfer Ownership ITransfer New Location:Previous location
BUSINESS NAME (Sh oh)Co Se, / Sd- J' _ 544,40N S a../GC...CS,S Or l '-O
LOCATION ADDRESS 363 7L19 nin0 Nub .
MAILING ADDRESS i i ? e r A T s A, C..,...: g U Q `-G 3—2L
BUSINESS PHONE FAX CELL 704 g?/—C 7o Y Or
. �v e—I`' • 6086 7 7 y
EMAIL ADDRESS e_. " or ■ i� .=-//4__ ��0 ?''� , 7
NATURE OF THE BUSINESS(Please :e Specific) Esc_ /'GS Qi�C_G s-t a r1 f.---g
SQUARE FOOTAGE OF BUSINESS PREMISES / Sk i
(Include both buildings and outside areas used in conjunction with the bdiness,but not patron parking areas)
NUMBER&TYPE OF VENDING MACHINES(if any) ------
Section 2
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER l-ra bile)I f -- ----
HOME ADDRESS // $Iq • /17/97-1 C(; G
HOME PHONE „2- �
7 3 - ‘Y f SS#or Fed Employer ID# d 6 0 g2)__70 7 v —
DATE OF BIRTH ,s/ -//
1, t. DRIVER'S LICENSE# (Attach copy)
STATE LICENSE/CERTIFICATION/REGISTRATION#(if applicable,attach copy) -
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 tha • uance of a Local Business Tax Receipt by the City Clerk in no way relieves me of the responsibility of
compliance with at 1 ovision of le Code o rdinances pertaining to conducting a burin the City of Atlantic Beach.
(�
S _natur- /- ) / ,,/� Title
/'/ Gthil/Ffi2✓ /0?-49?
PRINT NAME D ate
dr thout
No person,firm or corporation: �G )t.
first obtaining a Local Business /,, /��/ 2/�,�� 65 /
il Section 4(For Office Use Onl} f7� /�f� /���
❑FULL YR ❑HALF YR 535 4 t. 6/✓�• /✓
❑ Fictitious Name Reg. ❑ Ci /1'` "' "�i��
OTHER Rec / ( ' 4 i a
i' li /
ZONING APPROVED BY_ q (/l/64.° /
aft '
BUILDING DEPT APPROVED "1-0-4,ti Av(----4th()Y2 —
FIRE DEPT APPROVED BY _
I • itif
CITY CLERK APPROVED BY • #3 .. /4# CO" v ,
Last Business Use: Last Business Name:
-.
C
_O
N
Q > 00
O
O _0 (0
O O
O u) co
V
Lc)
W
,,— (
O Q
N w P
� a
L C ..
Q C ..
Q w
E
0 vl
irEs U
C
o
U
O a
U C
d C
w O
\....)11DI Jd Z
C TS
0 -0 C
d J cn a) Y l
.c C nn
co E v
Z E
O O
F 0 7
Z 0
0 co
U o Z
a u O / \\1
cn W z °' F 4�
0 Q ° / 4u
J 0
J d 0
l i d'
m 0 0
0 o m .Q Z 0 m
E O °
m Z °a Z Z 0
Q a
0 3 N
,IZ.
U J Q U o 0 o Q Z Q Q O co aa) q I ✓ \A N- U J � Q C J _ O ce)m w Q CD U) a Z C") M v (.....
i
0 M N Q r
U `1
'
Q 0 N Q� 'r
CJ
CY L 0 a' Q
-X N (0 c;6 U D ° v O
=
Z 0
` U )
F- -c N , O C .. 0
(1)
< N J O C cO U m j p
:_ c
_ O o � U .
.L.; O Y a 'O Y v
.".-J.- L o d 0 ai < U m d *k E o,
Q- Q n. .0 C C c i .Q >, d a)
0 co co C c c --i Fes- -;..1) 0 d O a -)i n ~ a