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BTR APP C & C 36 W 6th St I CITY EROFATLANTIC BEA . 800 SEIvIQ�IOLE ROAD,ATLANTICNTICBEACH,FL 32233 8 Section 1 . .. .. _. . ._ APPLICATION FOR NEW LICENSE TRANSFER OF OWNERSHIP TRANSFER TONEW LOCATION TRANSFERRING FROM M0. BUSINESS NAME C+ Fisheries .ZDNc . LOCATION ADDRESS MALTING ADDRESS . :3(0 WeStSt- PHONE FAX EXPLAIN FULLY THE NATURE OF THE BUSINESS SQUARE FOOTAGE OF BUSINESS PREMISES -F' (Include both buildings and outside areas used in conjunction with the bYsiness,but not patron parking areas) NUMBER AND TYPE OF VENDING MACHINES(if any) rt LD'Y O1[f S ' �72IOYI Ci-5 fD A� u�aln� ca. ( r -c f n C Section 2. J1 I• I I. LOCAL PRINCIPAL OFFI AGjJ0 VRTER I a Imo. Cer�Uei0. HOME ADDRESS 3(p �i.)Dod COU C �Ta4t = 3d+, url 32-t3nn, DATE OF BIRTH i I - 1P5•(0.3 DRIVER'S LICENSE# r'. -4 3-'f15-0(Atlach copy) HOMEPHONE -24 -7(n;-d S.S.# OR FEDERAL EMPLOYERID IV 5669SA14 STATE LICENSE/CERTMCATION/REGISTRATION#(if applicable,attach copy) Section 3. 1,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 an occupational Ecense by the City Clerk in no way relieves me of the responsibility of wrap', ce w' all pr inions of the Code of Ordinances pertaining to conducting a business in the City of Atlantic Beach. Owner / PrPsidyi f i lure Title A-+i Ilio ria cn_ �E.zRa ? - i - 00 Print Name Dare NO PERSON,FLIM OR CORPORATION SHALL ENGAGE IN OR MANAGE ANY TRADE,BUSINESS,PROFESSION,OR OCCUPATION IN ATLANTIC BEACH WITHOUT FIRST OBTAINING ALICENSE AND PAYING AN ANNUAL FER APPLICATION AND/OR PAYMENT DOES NOT CONSTITUTE APPROVAL OR ISSUANCE OF A LICENSE. i Oa55 {v /Z Section 4.-(For office use only) } t q;S CODE#, e t,u,Q LICENSE# FEE PAID F YEAR STATE REG./CERT. HEALTH CERT. OTHER FICTITIOUS NAME REG._CORPORATION REG. REQUIRES COMM.APPROVAL:YESIN DATE APPROVED/DENIED BY COMM. BUILDING DEPT.APPROVAL BY DATE OC� FIRE DEPT.APPROVAL BY .fif. DATE 00 ZONING APPROVED BY DATE wew CITY CLERK APPROVAL BY DATE o -10 ADD — FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES FOOD SAFETY INSPECTION REPORT F.S. chapter 500 (850) 488-3951 Firm Number: 104922 Print Det.: November 9,1999 Firm Name: CB C FISHERIES Data of Visit: November 9,1999 Firm Location Address: 36 W 6TH ST ATLANTIC BEACH,FL 32233 Firm Mailing Address: 36 W STH ST ATLANTIC BEACH,FL 32233 Firm Typed3escription: 311 /FISH(WHOLE,GUT,FILLET) Firm Owner. MAYPORT C 8 C FISHERIES INC Owner Code: OVERALL RATING - FAIR On November 9,1999,C A C FISHERIES was inspected by JOHNNY BASS,a representative of Me Florida Department of Agriculture and Consumer Services and the Overall Sanitation Rating was FAIR. PERMIT APPLICATION INFORMATION Permit Application Information was verified with management. FIELD TESTS The following field tests were conducted with Me results as indicated: R Tests Illegal CERTIFIED FOOD MANAGER 1 0 LABELING 1 0 TEMPERATURE-COLD 3 0 VIOLATIONS 1'1Indicates a critical violation. The follovdng violations were noted: OUTSIDE GROUNDS 230 'Backflow prevention device is not installed at fixture or equipment where back siphonage can occur. NORTH GROUNDS. 233 Dumpster is not kept covered vMh lids or doom closed andlor with dumpster drain plug In place. LIDS ARE UP. 237 Walls,callings,attached equipment are not kept dean and free of excess grease m dust accumulation. ICE ROOM'S CEILING AND FRAMING. PROCESSING AREA 222 Food contact surfaces of equipment or utensils are not free of soil,oily residue or encrusted toad particles. SCALERS(2). COMMENTS STATE HACCP INSPECTION. A Supplemental Reportwas also issued during Me visit which includes Important information for management. DACS 3205 Rev.9/96 1 __ ___ __ - - - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - -- ---- - - --- State of Florida Department of Agriculture and Consumer Servicer- 2000 t3 pt Division of Food Safety 850-488-3951 Firm Number:- 104922 Tallahassee, Florida Expiration Date: December 31,2000 POST PERMIT Fee Amount Paid: 8310.00 CONSPICUOUSLY Annual Food Permit Permit Number: 00-811936-895309 . GOOD FOR ONE LOCATION This permit is issued under authority of Section 500.12,Florida Statutes,to: Finn Type: FISH (WHOLE, GUT, FILLET) C& C FISHERIES 36 W 6TH ST ATLANTIC BEACH, FL 32233-3486 -6 �J 000 BOB CR�A{WjF�ORD COMMISSIONER OF AGRICULTURE e W0 Xl F,W Rrm 6 rcquircJ of v fera. in Ne Uuv f of tnnutnnurin¢, a aekin . helJin,, 6 auapemleJ upon nota,if p nJitio s of the perm Pnr sinf,C C ! PrePanng.m xllinF RxN nl ufielevk of rclall.and nrn'h rieluleJ. i7 The Sunshine State — / Lw'B6EMABEA C626-015-63-425-0 t ATILLIO P CERQUEIRA In q 36 CILEWOOD CT JACKSONVILLE BCH,FL 3226640 eIg1M MiE sE% H T RESP. EN SE _ - 11-26-63 M &W I$R1EO F IRES WPLIGM 1161446 11-26-00 0731-6 Eo niaosT OpeM4on da mMlo hide wnctiWEes I'gI1MI1[bany.,Mytestnquiro by law TO OBTAIN AN OCCUPATIONAL LICENSE,PLEASE DO THE FOLLOWING: Submit the following to the City Clerk: Occupational License Application(the application must be completed IN FULL and SIGNED) Copy of Corporate document (one page only) showing state registration number Fictitious name registration or exemption / Copy of State registration or certification Health certificate Copy of driver's license or other picture ID Department of Agriculture& Consumer Services Registration or exemption Other Che the Building Depa ment Business License Checklist and when the requirements have been complied with, call 247-5526 to schedule a I building inspection Check the Fire Department Inspections Business License Checklist,/ and when the requirements have been complied with, call 630-09P to schedule a fire inspection When you have completed the checklist, please contact the office of the City Clerk at 247-5810 to verify that all requirements have been met. If you encounter any problems with any of these requirements, please let us know so we may assist you. 2-16-200 4:S9PM FROM P. S FLORIDA DEPARTMENT OF STATE Jim Smith Secretary of State November 15, 1988 MARLOW V. WHITE, ESQ 9218 CYPRESS GREEN DR. JACKSONVILLE, FL 32.216 Dear Mr. White: The Articles of Incorporation for MAYPORT C & C FISHERIES, INC. were filed on November 14, 1988, effective November 8, 1988, and assigned document number K45154. Your check for $48.00 covering the various fees has been received. 0Should you have any questions regarding this matter, please telephone (904)487-6052, the Domestic Filing Section. TRACEY A HALL Division of Corporations G12ee42 Division of Corporations • P.O. Box 6327 • Tallahassee, Florida 32314 2-16-200 4:58PM FROM P. 2 ARTICLES OF INCORPORATION ryDv14 20 PN 'b OF MPYPORT C & C FISHERIES, INC. The undersigned subscribers to these Articles of Incorporation hereby form a corporation for profit under the Florida General Corporation Act. 1. Name: The name of this corporation is Mayport C & C Fisheries, Inc. EFFEC 2. Nature. Purpose and PowersThis orporatTl DATE . shall have perpetual existence, commends execution and acknowledgement of these Artic have the power to act as a general or limited partner in any domestic or foreign limited or general partnership and to carry out all duties of the general partner as provided in Chapter 620, Florida Statutes, as well as engage In any lawful business and have all powers enumerated in the Florida General Corporation Act. 10W 3. Stock: This corporation is authorized to issue 7, 500 shares of $1. 00 par value commor, stock. 4. preemotive Rights: Every shareholder, upon the sale of any new stack in this corporation, shall have the right to purchase his prorate shares thereof at the price at which it is offered to others. 5. Initial F gist d Off ' aid Aaent. The street address of the initial registered offace of this corpora- tion is 580-A Mayport Road, Atlantic Beach, FL 32233, the name of the initial registered agent of this corporation at that office is Mr. Atill.o Cerqueira. 6. Initial Board of Directors: This. corporation shall have two directors initially. The number of direc- tors may be either increased or diminished from time to time by the bylaws but shall never be less than two. The names and the addresses of the initial directors are Mr. Ati1Lo Cerqueira o:f 580-A Mayport Road, Atlantic Broach, Florida 32233, and Mr. Glenn Connolly also of 560-A May- port Road, Atlantic_ Beach, Florida 32233. 1. Subscribers: The names and the addrecsas of the persons subscribing to these Articles are Mr. Atil Y'o Cer- queira of 580-A Mayport Road, Atlantic Beach, Florida t 32233, and Mr. Glenn Connolly also of 580-A Mayport Road, 'Atlantic Beach, Florida 32233. 2-16-200 d:S8PM FROM P. 3 � f I � Mayport C 6 C Fisheries, Inc. Articles of Incorporation Page 2 8. Director and Officer Eligibility: Ownership of stock shall not be required to make any person eligible to hold office either as a director or officer of this corp- oration. 9. Notice of Meetincs: Any subscriber or sharehold- er present at any meeting, either in person or by proxy, and any director present in person at any meeting of the Board of Directors shall conclusively be deemed to have received proper notice of such meeting unless objection is made at the meeting to any defect or insufficiency of notice. 10. Amendment,: This corporation reserves the right to amend or repeal any provisions contained in these Articles, or any amendment to them, and any right confer- red upon the shareholders is subject to this reservation. low,. Subscriber/Inco orator Ybscr Ibdcr/Irrcorporal STATE OF FLORIDA s. 5 Atlantic Beach COUNTY OF DUVAL BEFORE ME, the undersigned authority, personally ap- peared Atillio Cerqueira and Glenn Connolly vho executed the foregoing Articles of Incorporation in my presence on this dk' day of November, 1986. Nota / ub ✓ e state of Florida at Large. Com- mission expires �� N=trry N&P,Sled RrR, 2-16-200 4:59PM FROM P. d C E Dgg Hayport C & C Fisheries, Inc. icy la 4 E rN 16N Articles of Incorporation Page 3 IN COMPLIANCE with Section 48. 091, Florida Statutes, Hayport C & C Fisheries, Inc. , desiring to organize and qualify under the lava of the State of Florida,- with its principal place of business at 580-A Mayport Road, Atlan- tic Beach, Florida 32233, has named Mr. Atillio Cerqueira whose office address in also 580-A Bayport Road, Atlantic Beach, Florida 32233, as registered agent. Executed: (!/F/ FP Carpo to irectdr HAVING BEEN NAMED to accept service of process for the above named corporation, at the place designated above, I hereby agree to act in such capacity, and further agree to comply with the provisions of all statutes rela- tive to the proper and complete performance of d ties. Executed: 11 Nps i Registered. Ag/�5����