25 SAILFISH DR UNIT 43 - TAX APPLICATION 5014114 cD -Co o,S.
CITY OF ATLANTIC BEACH oR� 12.-31-16
800 SEMINOLE ROAD,ATLANTIC BEAC , 32233 QRil 'f o ZCAL fi
LOCAL BUSINESS TAX APPLICATION i a•31-ts
Section 1
APPLICATION TYPE: New Business ❑Transfer of Ownership
_Transfer to New Location:Previous Location
BUSINESS NAME: Aura Aerial & Yoga,LLC
LOCATION ADDRESS: 25 East Sailfish Drive Unit 43 Atlantic Beach, FL 32233
MAILING ADDRESS: 111 Evans Dr. Jacksonville Beach, FL 32250
BUSINESS PHONE: 904-472-5126 FAX: CELL: 904-472-5126
EMAIL ADDRESS:shannon.burbridge @gmail.com
BUSINESS ENTITY IDENTIFICATION NUMBER: Federal Employer I.D.Number 81-0709601
or
Social Security Number
PLEASE EXPLAIN THE NATURE OF THE BUSINESS:
Alternative fitness studio offering group classes and private instruction in aerial fitness, including, pole
dance, lyra, yoga, pilates and barre.
SQUARE FOOTAGE OF BUSINESS PREMISES: 1,000 square feet
(Include both buildings and outside areas used in conjunction with the business,but not patron parking areas.)
WM the following be served? Food: Yes No
Alcohol: Yes No If yes,Select One: 1COP 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 e Shannon Burbrid
APPLICANT/LOCAL MANAGER/PRINCIPAL OFFICER: g
HOME ADDRESS: 111 Evans Dr Jacksonville Beach, FL 32250
HOME PHONE: CELL: 904-472-5126
DATE OF BIRTH: 01/26/1965 DRIVERS LICENSE#:B616-782-65-526-0 (Please attach a copy.)
EMAIL ADDRESS: shannon.burbridge @gmail.com
STATE LICENSE/CERTIFICATION/REGISTRATION#(if applicable,attach copy):
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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: Shanno Burb _
i TITLE: Owner
- if0SIGNATURE ' ~" l nfej / DATE 12/14/2015
No person, firm or corporation shall engage in or manage any trade, business, profession, or occupation in Atlantic Beach
without first obtaining a Local B ess Tax Receipt. Application and/or payment does not constitute approval or issuance of
a receipt. iG
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