Bus Lic 1400 VioletCITY OF ATLANTIC BEACH
j� 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233
APPLICATION FOR IV- NEW LICENSE TRANSFER OF AN OCCUPATIONAL
LICENSE TO CONDUCT THE FOLLOWING BUSINESS: (Check one)
BUSINESS NAME AIT1 W -eS ell --t`t UL_ �O slla WCI
BUSINESS LOCATION 1400 �41 d L - C ---r �Sr P't 1 L- Be-" .
SQUARE FOOTAGE OF BUSINESS PREMISES 101 ao-0
(INCLUDE BOSH BUILDINGS & OUTSIDE AREAS USED IN CONJUNCTION WITH SHE BUSINESS, BUT NOT AREAS USED FOR PATRON
PARKING)
MAILING ADDRESS 1 LDS V t()L6 1 -
EXPLAIN FULLY THE NATURE OF THE BUSINESS Y -Sus "C. I
%4COL=
92.., 6�sse S.
DO YOU HAVE, OR WILL YbV HAVE, ANY VENDING MACHINES ON THESE
PREMISES? 140 . (VENDING MACHINES INCLUDE AHOSEKENT/GAME MACHINES, POOL/BILLIARTSABLES,Er.ECTRORIC
MUSIC MACHINE AND ANY COIN OPERATED MACHINE WHICH DISPENSES A PRODUCT OR SERVICE)
IF YES, PLEASE INDICATE NUMBER AND TYPE OF MACHINES
OWNER/PRINCIPAL OFFICER j am _ P aTma
HOME ADDRESS tg ���
BUSINESS PHONE ,aq�(,n 3o&5 S HOME PHONE A4-� - 3og
DATE OF BIRTH O ~ - 1 - 39 SEX M DRIVERS LICENSE # P 3S0- 45(e- -3%p Ao l_ O
// (Attach cop }
FEDERAL EMPLOYER ID # 3- �_ �✓31t'O. OR S. S # �g� 3'O - 1�7
STATE LICENSE/CERTIFICATION/REGISTRATION #(If applicable)
(Attach copy)
I. THE UNDERSIGNED, SWEAR OR AFFIRM THAT SHE ABOVE STATEMENTS ARE TRUE AND CORRECT AND I AGREE TO NOTIFY SHE
CITY CLERK IF THERE IS ANY CHANGE IN THE ABOVE INFORMATION.
I FURTHER UNDERSTAND THAT ISSUANCE OF A LICENSE BY THE CITY CLERK IN NO LAY RELIEVES ME OF THE RESPONSIBILITY
FOR COMP CE WITH ALL PROVISIONS OF THE CODE OF ORDIIANCES PERTAINING TO CONDUCTING A
BUS IN THE CITY O -BEACH
Sig attire Title_.
Print Name Date
NOTE: NO PERSON, FIRM, OR CORPORATION SHALL ENGAGE IN OR MANAGE
ANY TRADE, BUSINESS, PROFESSION, OR OCCUPATION IN ATLANTIC BEACH
WITHOUT FIRST OBTAINING A LICENSE AND PAYING AN ANNUAL FEE.
APPLICATION AND/OR PAYMENT DOES NOT CONSTITUTE APPROVAL OR ISSUANCE
OF A LICENSE.
ALL OCCUPATIONAL LICENSES EXPIRE SEPTEMBER 30 OF EACH YEAR
FOR OFFICE USE ONLY
LICENSE NUMBER(S)CODE NUMBER `S 70
FULL / HALF YEAR FEE PAID
REQUIRES CITY COMMISSION APPROVAL: YES / NO
APPROVED / DENIED BY COMMISSION (DATE)
STATE REGISTRATION/CERTIFICATION REQUIRED: YES / NO
BUILDING OFFICIAL APPROVAL FIRE DEPARTMENT APPROVAL
BY ���/' BY
DATE-�� -7�� DATE
7<X4A DATE
MAUREEN KING, C TY 6tL RK