28 SHERRY DR - LOCAL BUS TAX APPLICATION CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD,ATLANTIC BEACH, FL 32233
LOCAL BUSINESS TAX APPLICATION
Section 1
APPLICATION TYPE: New Business IS Transfer of Ownership
Transfer to New Location: Previous Location
BUSINESS NAME: The Color Black, LLC dba 28 Sherry
LOCATION ADDRESS: 28 Sherry Drive Atlantic Beach, FL 32233
MAILING ADDRESS: PO Box 49160 Jacksonville Beach, FL 32240
BUSINESS PHONE: 904-241-7776 FAX: CELL. 904-545-7788
EMAIL ADDRESS:Sara @28sherry.c0m
BUSINESS ENTITY IDENTIFICATION NUMBER: Federal Employer I.D.Number 47-3150568
or
Social Security Number
PLEASE EXPLAIN THE NATURE OF THE BUSINESS:
hotel
SQUARE FOOTAGE OF BUSINESS PREMISES: approx 10,000
(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: I COP 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:
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Section 2
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER: Stevan Brown
HOME ADDRESS: 8t2,Second St. Neptune Beach, FL 3226
HOME PHONE: CELL: t 04-226-8782 gE9 1l ceitot (4
DATE OF BIRTH: 02/02/1986 DRIVERS LICENSE#: — 1� 7- (Please attach a copy.)
EMAIL ADDRESS: stevan@28sherry.com —
STATE LICENSE/CERTIFICATION/REGISTRATION#(if applicable,attach copy): B650-797-86-542-0
Section 3 mo-falai)i'300
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 compli• e with all provisions of the Code of Ordinances pertaining to conducting a business in the
City of Atlantic Beac
PRINT NAME: - I Brown TITLE: Managing Member
SIGNAT d4,111W DATE 3/IA
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.
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