HomeMy WebLinkAboutOrders_Variances_10/08/2015_VAR 03-15_Oceana Logistics Int. ORDER OF THE VILLAGE COUNCIL
VILLAGE OF TEQUESTA
REQUEST FOR VARIANCE
CASE NO.: VAR -03 -15
IN RE: Oceana Logistics Int., Inc., dba Oceana Coffee, Applicant
SLO -ML, LLC dba Tequesta Fashion Mall, Owner
PROPERTY LOCATION:
150 North U.S. #1, Unit 1,Tequesta, FL 33469
(Fashion Mall Unit 1)
LEGAL DESCRIPTION:
30- 40 -43, SLY 7t8.76 FT OF NLY 1118.76 FT OF ELY 254.83 FT OF GOV LT 3 LYG W OF &
ADJ TO US HW ' 1
PARCEL CONTROL NUMBER:
60- 43- 40- 30 -00- 003 -0070
VARIANCE REQUESTED:
Variance from Sec.78 -298 to allow the consumption on premises (restaurant use) of
alcoholic beverages within 1000 feet of a church in the MU Mixed Use Zoning
District.
ORDER APPROVING APPLICATION
This cause came on to be heard upon the above application and the Tequesta Village
Council having considered the evidence presented by the applicant and other interested persons at a
hearing called and properly noticed, and the Tequesta Village Council, being otherwise duly
advised,
THEREUPON, THE TEQUESTA VILLAGE COUNCIL FINDS AS FOLLOWS:
1. The subject property is located in the MU Mixed Use Zoning District in the Village
of Tequesta.
2. The applicant has submitted all documents required by the Village's Code of
Ordinances for variance review.
3. The application and all supporting documentation and presentation materials as
reviewed by the Village Council at its October 8, 2015 meeting, and as kept on file
by the Village, are made a part hereof and are hereby incorporated by reference.
Page 1
4. According to Section 78 -61, variance approval by the Village Council is required.
5. The applicants have applied for a variance from Sec.78 -298 to allow the
consumption on premises (restaurant use) of alcoholic beverages within 1000 feet of
a church in the MU Mixed Use Zoning District.
6. Under the provisions of the Village Code of Ordinances, the Village Council has the
right, power and authority to act upon the request herein made.
IT IS THEREUPON CONSIDERED, ORDERED AND ADJUDGED BY THE VILLAGE
COUNCIL OF THE VILLAGE OF TEQUESTA, FLORIDA, AS FOLLOWS:
The application for Variance, Case No. VAR -03 -15 with reference to the above described
property within the Village of Tequesta, Palm Beach County, Florida, to allow the consumption on
premises (restaurant use) of alcoholic beverages within 1000 feet of a church in the MU Mixed Use
Zoning District in accordance with the variance application attached hereto as Exhibit "A" is hereby
APPROVED since the Village Council hereby finds that the applicants have met the standards set
forth in Section 78 -65 of the Tequesta Zoning Code for variance approval.
* The term applicant(s) as used herein shall include all successors and assigns.
* The variance shall expire within six months from the date of grant, unless a building permit
based upon and incorporating the variance is issued within the six -month period and
construction has begun thereunder.
DONE AND ORDERED THIS ' DAY OF OCTOBER, 2015.
Al
'1
L
YO AB AIL BRENNAN,
VILL GE OF TEQUESTA
LORI McWILLIAMS, MM ''�
VILLAGE CLERK .L :�= FILED Village of Teq uesta
1 NCORPORRTEI) Date:
Time: (r� A-
op
Page 2
� VILLAGE OF TEQUESTA ;-___- OFFICE_USEONLY___ _ �
Department of Community Development � ;
s 345 Tequesta Drive
� Village Council C] �
�• Tequesta, Fiorida 33469 � P�anning & Zoning Board 0�
Ph: 561-768-0451 / Fax: 561-768-0698 � ;
www.tequesta.org ; VAR# ��..» ( �, '
�
� - ,
'----------------------------'
APPLICATION FOR VARIANCE
PROJECT NAME: QCeavlal COC-C�--c.a2..
PROJECT ADDRESS: I'�"J O N. V S' �}-�Wy �.. '"j'F (��,V�SC'A. �, 33N �q
Applicant Name: � .e- � O C.,�ctN1 t1� t.b ► S�i CS ��r1^} . �� �,
Applicant Address: 221 Q 1'!� 'D � X i E �{W-� �,�. �"'�"Equ�,TA 33� <o
Applicant Phone No.: _��01. �3�, 2..� l 3 Fax No.:
Cell Phone No.: E-rnail Address: Camy .anqQ lo @ ocPA�a
Provide written approval from the property owner, if other than the applicant. � CO C . co r✓�
Property Owner's Name: Iv� i 1L� L�eu�-k.e w,e e r
Property Owner's Address: 'P.O . �aX �{� 23 '�v�l-�+'', ��-� 3 3 � (,o�
F'roperty Owner's Phone No.:_'�-� t'S 5��,13lc8 Fax No.: E-mail Address: Yhi k! 1� ZS4 q� Qa�. to�
NATURE OF VARIANCE: ��!'QY�ahC9. �v -}'�. r eQa;re,�v�u,n�'S 6� SS`�1$-2q�
whir,.k� roh�bi�S Z o�- ir� ' c.a�1-► behexa u s wi�lni
� Q 0� �, raed Z 1 OF- ah�/ �e.,.r�'1 Cr^ 0� � C�r \
----.��►.yl�r � —
n APpLICANT SHALL INCLUDE THE FOLLOWING ITEMS WITH THIS APPLICATION:
1) Current survey or site plan of property shawing all structures and setbacks.
2) Drawings to scale of proposed improvements.
3) Variance Criteria Response — page 2 of application.
4) Any other documentation pertinent to this application.
5) 15 Copies of all submittals
6) L.ist of all property owners within 300' radius of the outermost perimeter of subject property, obtained from PBC
Property Appraisers Office, & stamped envelopes for each.
7) Application Fee of: A) Single Family: $ 300.00
B) Duplex: 700.00
C) . ' ily: 1000.00
D) Commercial:� 000.
' cover all additional administrative costs, actual or anticipated, including, but not limited to, engineering fees, consultant fees and
SPecial studies, the applicant shall compensate the Village for all such costs prior to the processing of the application or not later ihan
��rty (30) days after final application approval, whichever is determined as appropriate by the Village.
S � G NATURE OF APPLICANT: DATE: 8 1 Z- I�
���e 1 of 2 �
JUSTI�ICATION OF VARIANCE: You must provide a response to each af the following ques#ion's per Zoning Code
Sec. 78-65 (2) a.-f. If additional space is needed, piease attach extra pages to this applicatian. If your variance request
is related to the public wate�s of the state comprising the Loxahatchee River and the Intracoastaf Waterway and all
creeks, canals or waten�vays or #ributaries connected therewith, located within the geographical boundaries of the Village,
you must also address the ten criteria listed in the Sec.76-7.
1. Special conditions and circumstances exist which are peculiar to the land, structure, or building involved and which are not
applicable to other lands, structures or buildings in the same zoning distri�t.
�c�A �'�l'-�-+=- � s_ 1 a ra� w i-�+ti r i� do o�.�- o F
g� . �'�e1� C.Inu►trGh . "�ln-er6t Gr4 i('2�au�ra✓ti�'S � +� �'i..�. �n^2
.T Za �In i C;h t� r� r� b le �}v Se,rve , al co1�o� , c la��re,rr�� ,
2 7he special canditions and circumstances do not result from the actions of the applicant.
� � a��� 17l O 11�g A r t" 4 lS Q �'e �1 �'r` C► �-�w.�,
�..,�?_y"= P�,� C°�CeQr�Gt C'o�('.�¢n.. �O�e 3�. 10 CQ cl W+�.� v,
1. O O C) �• bF' �'� •�Uc� Q �OC�`� �� C � r C�'1 � rl l?'�' �ir'a M
Q Y �1+� "�"j Oh5 OF 'Th.�- QQP� � C0.+''1 .
3 Granting the variance requested wil! not confer on the applicant any special privilege that is denied by this chapter lo other
lands, buildings or structures in the same zoning district.
�Q� � � VQ Y' �Ql+n G.. W J I � R( I�U O ClLAy10� COfiC-e�L '}p
��XV�. Q� C0�`+�f`1G ��f�'OI�Q'�� G�� Y11`Q��' � TOY ��1 Q, Q��� .
� � �� -
4 Li#eral interprstation af the provisions of this chapter would deprive the app�icant of rights commonly enjoyed by other
prope�ties in the same zoning district under the terms of this chapter and wauld woik unnecessary and undue hardship on the
applicant.
��-e. a o�o..� esk�bl�slnr��s �v� -4M.+� sq� �a�z.R
��.�� sln� or� M�L, ir�oa.�- ar-e aloL�. -4v s.�ar-,.e a 1 colno l� c. �c�rac�.;
5 7he variance granted is the minimum variance that witl make possible the reasanabte use of tne land, building or structure.
�ear�o� Co�- w o� 1d li ka. -� �e+�v.e all �-a he 1�c �we�,�x�a�4s
a� r�� �r avxl �,�-- �c3.�L e�e•� ."�► � S ,�� t 1_ cx-.ea a_
�' C. lass � ra 1 cv�' c�. 1 ac,�. �- o �.�,. v. i�-�
�.r� 1C wlni �► , 1 i S i 5� �t 10 �a 1 ac o us-hi c rh vs ir or
a���P C�n�"1 Sb� � C Q l a r�-
6 The gra # e va iance u�' be in harmony with t e general intent and purpose of this chapter and such variance wili not be
injurious to the area involved or otherwise detrimental fo the public welfare.
(�ceo�na�. C��'-�'.�. wi 11 re�.a� � as aiwaus ., a� ups��� rq
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,�
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s St. Jude Cath.olic Church
204 N. US Highway �ne--P.O. Box 3726, Tequesta, FL 3346g
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August 24, 2�15
Village of Tequesta •
357 Tequesta Drive
Tequesta, FL 33469 � ;
RE: The t�cea�aa Coffee
150 N US Hwy One, Unit 1 �
Tequesta, FL 334b9
To Wham It May Conc�rn:
� I have been ixafozax�.ed that Oceana Coffee is in the process a� applying for a beer and wine lzcense
for their events in the evening. S� Jude Catholic Charch has no objection af selIing intoxicating
� bevez�ges for consuinption on the premises. We aze awaze that the establishment is within the
1,000 feet of the church.
T want to wish them the best in their new restaurant_
If you have a question, please do not hesita#e to contact me.
Sincerely,
C;?����- �' �
Rev. Ch�arles E. Notabartala
Pastor
CEN/ls
phone {561) 746-'7974 � fax {561) 743-6127 � e•mail infostjudeQa beilsouth.net
website www stjudecatholicchurcb.net
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Instructional Videos �: ;�4. _, � ' " 6 w �4r . �� � ��' I� � } ����::. � � .'��
August 25, 2015
Village of Tequesta
Department af Camrnunity Development
345 Tequesta �rive
Tequesta, Florida 33469
Re: Oceana Coffee
150 N. t1S 1'fequesta, Ffarida 33469
Dear S'rr or Madam,
This letter serves as notificat€on to the Vlllage of Tequesta from SL()-ML LLC dba The Tequesta Fashton
Mall that Amy Angeto of Oceana Coffee has a lease to operate �ceana Coffee atThe Tequesta Fashlan
Mall. Under th}s circumstance, we would like to grant �ceana Coffee permission ta se11 beer and wine
for on-site consumption, provided that Oceana Coffee abtains all required permits and Ilcenses frorn the
appropriate authoritles for the Tequesta Fashion Matl location.
Please feel free to cantact me at 4i5-509-1368 (ceff number), or at mike102549@aol.com shouid you
have any questions.
Your cooperation is reeiated.
Sin re ,
Micha I et emeye , Princ�pa d Partner
Sl0-M C dba The Tequest ashfon Mall
Relafed Party Personal lnformatio�
This section of the appiication musf be complefed by each applicant or person(s) directly connected with fhe
business, unless #hey are a current licensee. The signafure of each persan filling out fhis section of the
application must be an original. This will include the sa�e proprietar, all parkners, officers, directors, individual
share holders owning more than'/� af 1 percent af stock In non-public carporafions, ail partners of each general
partnership, all general partners of a limited partnership, all managing members or managers of a limited tiability
company, partners of a limfted liability partnership, and persons directly interested and receiving financial
proceeds from the business. It is important that each individuaf discfoses any arrests they have had within the
past 15 years, even if fhey were charged, but not formal[y arrested, and regard�ess of the disposition.
Copy of Arrest Disposition
[f the applicant answers "yes° to any oi the criminal background questions asked in this application, provide a
copy of the Arres# Disposition to ensure the applicant is qualified, pursuant ta Statute and Rufe.
Appllcable Statutes and Ruie: Sfi1.15 8� b67.17, Florida 5tafutes; and 61A-1.017, Flarida Administrative Code.
Mora! Character
The applicant is required to meet the moral character standards fo have an interest in an alcoholic beverage
license. Any person failing to meet those standards shalf be required to submi# mitigation under the moral
characfer rule in order for the division to determine if the person is qualified. A ca�y of the rule and requirements �
can be found 8t https:l/www.flrules.orglgateway/RuleNo.asn?fitle=D�FINITIONS&ID=61A-1.017.
Federal Employer's Identtffcation Number (FElN)
All licensees wha pay wages to one or more employees must have a Federal Employars Idenfificafion Number.
' Confact the Internal Revenue Service (1RS} at 1-800-829-3676 and request Form #SS4.
Surety Bond
Surety bonds are required on all new applications for manufacturers, whalesale distribu#ors of alcoholic
beverages, wholesale distributors of cigareftes, and other tobacco products. A surety bond or a rider to the
original bond must be submitted on any change of business name, change of locatian or change of ownership
name application by the aforementioned. You may wish to have an auditor review your surety bond prior ta
submitting this application. Contact the division's Auditing Office serving your area of interest for further
informatian. A list of the Auditing offices can be found at:
http:tlwww.mvfloridalicense.cam/dbpr/abt/district officestauditing.hfml.
Sketch of Premises
A complete skefch of the premises, drawn in ink or computer generated (letter size} which includes afl permanent
walls, doors, windows, counters, fabeling each room and area. Include any outside areas where afcoholic
beverages will bs sold, consumed, or served. �ue to the dlfflcufty of scanning, no blueprints are accep#ed.
APPL[CATION CHECKLIST
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I N RE EMENTS"; � =.. -- �. �;. _:.
7RANSACTI�N;. ' �. : -; `::<_:"::-:� '.AI�PL CATtO _ QUIR . >�;'.�` "`� -
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Camplefe DBPR Division ofAlcoholic Beverages and
Tobacca Application #or New Alcaholic Beverage License
O Pay $100 or'/, of the annual license fee, whichever is grea#er, if
requesting a temporary license (make check payable to the Division
of Alcohofic Beverages and Tobacco)
New Ucense ❑ Submit Fingerprint receipt, if applicable �
�Submif a copy of Arrest Disposition, if applicable
..�' Submit Mifigafion for Maral Character, if applicable
�'"Manufacfurers and wholesale distributors of aicaholic beverages
must complete and submit the DBPR ABT-6Q32 Surety Bond form
❑ Submit Right of Occupancy
.� .
Appllcation may also include �New Ratail Tobacco Products Dealer Permit
Auth. 69A 5.010 8 64A-5.056, FAC 4
DBPR ABT-6�01 — Divis�on of Alcoholic Beverages and Tobacco
Application for New Alcohotic Beverage l.lcense
STATE OF FLORIDA DBPR Form
D�PARTMENT OF �USINESS AND PRO�ESS{ONAL REGULATION ABT-600'!
Revtsed 08/2Q13
If you have any questions or need assistance in complefing this applicafion, please contact the Division of
Alcoholrc Beverages & Tabacco`s (AB&T) local dlsfrict office. Please submit your completed applicafion
and required fee(s) to your loca! district office. This application may be submitted by marl, through
apporntmenf, vr if cen be dmpped off. A District ��ce Address and Confact Infarmafion Sheef can ba
found on AB&T's web site st fhe !!nk provided below:
hftp:/lwww.rnvflorida.com/dbpr/abt/district officesilicensina.html
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,;, :. ..;,:,�_::.;,:,:::;��... EC71 N:- �.CH K�LICEN � C TE ORY:'��:::_`':`;.:.;:;_�,:<:�:��.;;`.;•:;_::.�.°:;<;::::
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Lice e Ser' s Requested Type/Class Requesfed Do you wis to pu�chase a 7emporary i.icense?
�C O � Yes No
ChiEd License Requested iVumber of Child Licenses Requested
�+ Retail Alcoholic Beverages ❑ Alcoholic Beverage Manufacturer
❑ Beer/Wine/Liquor Whalesaler ❑ Passenger Waiting Lounge
❑ Retail Tobacco Products Dealer Permit (must check one or more of the befow)
❑ Pi es ❑ Over the Counter ❑ Vendin Machine
,.. . . . - - - - - - -
.;:�:.:
. . . ..... ....� � ..ti'.=�':;.x;:Y - -
- - - SECTION.:2`=:LICENSE�INFORMA7[ONo'#�� - s'�'�` ` - °'' - -
�.:Y..-:
. � .. - _. .... . .......'� . s .. . .- . ... :. . . . a. .: .... t_ �. . : . -_ .:..::' : . .. .
If the applicant is a corporation or other legal entity, enter the name and the document�number as registered
with the Flarida Department of State Division of Corporations on the line below.
FEIN Nurnber Business Teiephone Number E-Mail Address (Opfional)
2'� - 02.4 b 1'z--� �5t�1 �{ o► 2y5 � a rn� . a lo @ oc�ea►+na►coc�be � r►�
Full Name of Ap licant(s): (This is the name the license will be issued in) Department of State pocument #
Ot� a►+na. �,a '� S'11 CS h�. C,
Business Name (D/ )
�Gear.a. C s��
L,ocation Address (Street and Number)
. S. �-
City Caunty SEate zip Code
'�.L� Uts� a 1 r r� �.�.°a[k1 Fc. 3 toq
Mailing Address (Sfreet or P.O. Box)
2'Zt 1d '� 1 c '� �.-
City State Zi Code
�d�Es�c� �- �suc�g
�`'= ":=.: �� '"Contact Person = ThEs sectfon is o tional;`see a Ilcation�lnstructidtis for detafls:` -::." ;`:�;::::_
Contact Person Tefephone Number
{�Y��, .e � v 3q •'7-�11.3 ext.
E-Mail Address (Optional)
. aln 10 O cearwCO�� . C.o M
Mailing Address (Stre t or P.O. x}
�Arn.O.. aC5 t� w�-
��ry - State Zip Code
AB7 Dlstrict Offlce Recelved pafe Stamp
Aufh. 61A-5.010 8 61A-5.056, FAC 1
':;;�::��:`:°:`�;:;;;:':::;` ��'=:,: ��� -, .:; SECTION;3 �:RELATED PAR7Y PERSONAL: INFORMA7ION �:�::�:�.: :;"=,::;;;::��:-:�.:,: °.: � :�:::::
,Th sectlon m,ust,be, completed,fo.r;each:persq
= ry
are.a;current`licensee. , . '' � "'� � � � ` - - - -
. .. .
.
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.
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.. . • . .-: . . .. .. ...... ' .
1. 8usiness Name {D/B/A)
Oc.earc Caf{'�
2, Full Name of Individual
,�rd
Socia! Security Nu ber* Ho Teteph ne Number Date of Birth
2. `13 � 8''t 3 S to 1. 33� . 2q I'3 1"`l a1"l
Race Sex Height Wei E Ca1or Hair Co ar
'�' S' 3` � '(31�1� gI.ON
3. A e you a U.S. citizen?
� Yes ❑ No
!f no, immigration card number or passpo�t number:
4. Home Address (Street and Number)
60 � 5 "3�Q..
City �� Stat Zi Code
�. 3 � ��
5. Do yoa currenfly own or have an interest in any 6usiness selling aicoholic beverages, wholesale
cigarette or tobacco products, or a bottle club?
❑ Yes � No
!f es rovide the information re uested below. The Iocation address should include the cit and state.
Business Name (D/B!A) License Number
Location Address
S. Have you had any type of alcohotic beveraqe, or botfle club license, or cigarette, or tobacca permit
refused, re ked or suspended anywhere in the past 15 years?
❑ Yes �No
If es, ravide the information re uested below. 7he lacation address should include the ci and sfate.
8usiness Name (D/B/A) Date
Location Address
7. Have yau been convicted of a telonv within the past t 5 years? Yes o
If yes, pravide the infarrnafion requested belaw and provide a Copy of the Arrest Disposition, as
re uested in ihe A lication Re uirements checklist.
Date Locafion
Type of Offense �
8. Have you been convicted of an offense involving alcohofic beverages or tobacco products anywhere
within the past 5 years? ❑ Yes ❑ No
If yes, provide the infarmation requested below and provide a Copy of the Arrest Dispositton, as
re uested in the A lication Re uirements cF�ecklisf.
Date Location
Type of Offense
Auth. 69A-5.010 8 87A-5.�56, RAC �
9. Have you been arrested or issued a notice fo appear in any s#ate of the United States or its #erritories
within the past 15 years? ❑ Yes ❑ No
lf yes pravide the information requested below and a Copy of the Arrest Dispositian.
AEtac additional sheet If necessa .
Date �.ocation
Type f Offense
10. D y u meet the standards of the moral character rule?
�Y s ❑ No
91. Are y u an officer or employee of Ehe Division of Alcoholic Beverages and Tobacco; are you a sheriff or
other tate , county , or municipal office�, including reserve or auxiliary officers, certified by the state as
• such, it rrest powers, whose cerfifcation is current and active?
❑ Y s �No
... ... : .. _ - - -
. : ... :. . .....:.. . : '..:: .'.: • � . ..' " ' .'._' . ":4�:'-,i -
- =NQTARIZATION:ST;QT�MENT°
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"I swear u der aafh or a#frma#ion under penalty of perjury as provided for in Secfions 559.791, 562.45 and
837.06, FI rida Statutes, that I have fully disclosed any and all parties financia8y and or contractually
interestecl in #his business and Fhat the parties are disclosed in fhe Discfosure of Enterested Parties of this
application 1 further swear or affirm thaf the foregoing information is f�ue and correct."
STA7E OF -
COUNTY F G��:�"L.. .
' A PLICANT SIGNAT E
The forego ng was () Sworn to and Subscribed OR (} Acknowledged before me �h . l Day
` ��������Q�g ���i
o# , 20�By � . .•• ��a�js �_ ersonaify
(print na e of person aking stater�ntZ.•'�5 �"a °�'9F�• �
� • �'� oy s : �c �
� ! c� .'e ` " r
known to me OF2 (} who produced =�'` m .• as ��ification.
r' ,K : ,� ' a �
' i �.! ��� •���`
. Commission E�'. T��" •'.�t"
•� •M�
o ary Public ���ip
/
(ATTACH DDiTIONAI, COPIES AS NECESSARY}
*Social Se urity Number
Under the ederal Privacy Act, disclosure of Sociaf 5ecuriry nurnbers is voluntary unless a Federal
statute sp itically requires it or allows states to collect the n�mber. In this insta�ce, disclosure af social
security nu bers is mandatory pursuant ta Title 42 United States Code, 5ecfions 653 and 654; and
sections 40 .2577, 409.2598, and 559.79, Florida Statufes. Social Security numbers are usecf to aflow
efficient sc ening of applicants and licensees by a Title iV-D child support agency to assure compliance
with child s pport obligations. Sacia[ Security numbers must also be recorded on all professiona[ and
occupation I license applications and are used for licensee identificat9on pursuant to the Personal
Responsibi ity and Work Opportunity Reconciliation Act of 1996 {V1Jelfare Reform Act), 904 Pub.l..193,
Sec. 317. he State of Florida is authorized ta collect the social se�urity number of licensees pursuant to
khe Social ecurity Ac#, 42 U.S.C. 405(c)(2)(C)p}. 7his information is used to identify licensees for tax
administraton �urposes. This infoRnatian is used to identify licensees fortax administration purposes,
and the div sion will redact the infamation from any public records request.
Auth. S1A�. '!0 8 61A-5.OSfi, FAC 3
--_ . .:
:
SECTiON 4;=:DESCRiPTION OF:PREMISES:TO BE LICENSED :' �=::�:' _��::� ;:::: :�:- ~ ::; : `- "�
_.. .... . _..... ... .
.... . : .... . ..
.:. . : .. ..:.:.. . :. :..:.::' :.::.: TO BE COMPLETED.BY:THE�APP.LICANT;::.: �:::=. ` : :`..: ..;:: ::_::�,;,.;._, : ..; �;��;,; ::;:_..;:::
Business Name (D/B/A)
9. Yes ❑ No fs the praposed premises movable or able to be moved?
2. Yes O IVo� Is fhere any access Ehrough fhe premises to any area over which you do not have
dominion and control7
3. Yes ❑ No;l� �$ the business located within a Specialty Center? If yes, check the appiicable statute:
❑ 56'i.20 2 b 1 F.S. or ❑ 56120 2 2 F.S.
4. Yes � N Are there any mobile vehiclas used to sell or senre alcoholic beverages?
5. Yes ❑ �Vo� Are there more than 3 separate rooms or enclosures with permanent bars or
caunters?
Neatly draw a floor plan of the premises in ink, including sidev+ralks and other outside areas which are contiguaus to the
prernises, walls, daors, couriters, sales areas, storage areas, restrooms, bar tocations and any other specific areas which
are part of the pr�nises sough# to be licensed. A mulEi-story building wFSere the entire building is to be licensed rnust
show the details of each floor.
Auth, 61A-8.010 & 61A-5.Ob6, FAC 4
... .
: SEC7lON 5 = APPL[CA71UN �APPROVAL:S `:� .;�': v; ='-� `:::':' ::': �`:.`�- ' ;� : ::'; �: �- .
.... . . .: . . ...
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Fuli lVame of Applicant: (This is the name the license will be issued in)
LA � S�'3' CS � h�}-� vti C•
Business Name {DIB/A)
�Eb1V'�A C O�G�2Q
Street Address u � , L _ _ � � �
' � b N . ��w
c�fy .--r—�-QU�'1`�- cour,ty � � FcLt� 3��acp
�. .
_,Q'. :��_� : § �" _ � . ° >�4 _
A. The location complies with zoning requirements for the sale of alcoholic beverages or whalesale
tobacco products pursuant to this application for a Series: Type: license.
B. This approval includes outside areas which are configuous to the premises which are to be part of #he
�remises sought to be licensed and are it4entified on the sketch?° ❑ Yes ❑ No
Cf�eck either: Please do not skip, this is important for license fee sharing
❑ Location is within the city limits or ❑ E.ocation is in the unincorporated cotanEy
Signed Date
Titfe This approval is valid far,� days.
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. .:.: . . . . .: ::: . :.: :�'<:TO.BE�.COMPL�TED ;=�'.�:;:`;:_;"::'':�:�;:�''?=:`;ri:=;.�;�;w
The named applicant for a license/permit has complied with fhe Ftorida Sfatutes cancerning registrafion for
Sales and Use Tax.
1. This is to verify that the cuRent owner as named in this application has �led all returns and Ehat a!1
autstanding biilings and returns appear to have been paid through the period ending�''�V Ly 201�
or the liability has been ecknowledged and agreed to be paid by the applicant. 1"his verifica#ion does not
constitute a certificate as contained in Seetion 213.758 (4), F.S. (Not applicable if no transfer involved).
2. Furtherrnore, the named applicant for an Alcoholic Severage License has compfied with Florida Statutes
concerning registration for Safes and Use Tax, and has paid any applicabfe taxes due.
Signed Date
7+tle Departmenf of Revenue 5tamp
This approval is vaIid for days.
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a .. �:,.'';. M` "i_ `"3::s ��?.t1:!��>: _� :t :t�`� �. _�.. :,5ern• _ t. a... n•..�.�.b �.t''�'
' ='' ,� ¢'�" .#. .. • _ - UI�OF:,Hf�7E��b�RES AiiRANT �
4 - ?: ="� �> :�.'�=T.O,`BE�'CbMPLET�D:BY�-`T�I�:DIV1S1 S .�"= ���
^�i':.. �� ���;:.:5'� , t. t. _ _ �€. �u�. : y_ - .3 .�.r " :Z .. ,{.._ ..rr,.x,•,. _ 78;, h:.e' i,v� :;y � : zh',;�'+�`.�'",�. � �,��:,'L:w�'
.�'iti K . r : as "y „ �"'�e:�'a�_ i t :RT�:� , :,tr+;.. �!,��' � ) � - aFg'. ��-.'St�':�,
�... _ �,::_` - �3 �OR;C.OUNTY;HEA1:aTH:�T d;�ITY�Y `-"�s� `� �� ,�.. ,�.
. �.a.. � -- ��� •�.,- �" ��>..�: .°�
F' ` 'ry'-'?.' ' . �: : �:i �i��+r�' . . i— 4... Y "a4: ' • �1:'� �{ 'fL'-.'' Ta"�'cf��' ' .0
'��. �i',,::'.'': a� i:i:f:;:: '::t�`ry' -.+.rtt'�.. : x� : i"{3; M �3 ��'*y: {.< ..� - •-Y'; = s �> ' ? �r�f �x a�':*t�.
_.,:,��.;�.�;: : ��.. - ..<, �.. zOR�,D.�PARTM�IVT;O :� A ,. 4T: :1i: :� :�: �.� ..4. r; �"�:.: <,.. - �_�
':sq...?.d._$.; r.:`u;: : [t: �"� .:yc.,,..n:r.A-,7S �r.�i- .,,k.f -:a:. • 5T
�,':aia"sitq��. �•, `'� �. '`'t s,. �:�
l�:t� �' •p.g�i, �.:t�i}4:;�,. _ _ £Y •_'; 7;; .�',.
.3:::. �O�R� FtfCU 3��: �.:::
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7he above establishment complies with the requirements of the Florida Sanitary Code.
Signed Qate � '
7��e Agency
This approval is valid for days.
Au#h. 67 A�.016 & 61AS.056, FAC 5
� _ �:" SECTI4N:6=APPLICANT�ENTI7Y�FELONY,��ONVICTION,-::_ .:' :'- -:..::_:'.--:: �;�:.: '::;:.:.
Business Name (D/B!A)
Has the applicanf enfity been canvicted af a felony in this state, any other state, or by fhe United States in
the last 1 ars?
❑ Yes �lo
!f the answer is "Yes,' pEease lisf all details including the date of conviction, the crime for which the entity
was convicted, and the city, county, state and caurt where the conviction took place.
{Attach additional sheets if necessary)
�,.�:;�-.�;�:�:�=:-'.°;: � O �:SF L'Lf UI EMENTS:«�{�,Y�,,�:,;;�;,�n:._v;�s°,..:<�a:
,..;. °:'.
..�._.,��:.:..:: >:.. .:.:..,._�;�;;,r::<;:,�;..,;:::•:S�CTI .N7 _..:ECIA_._..CEN$E�;R, Q,,
.. - - �� -
��;::"-_�,�-.-.•.. , : ,. '
_,�..,.. . . . .�. .. . DOES NOT�APPLY.TO B��RAND�.W,INE:LICEN$ES ��}'y'';�=�`_���. _
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.
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. .. .. . . . , . . _. . ...
Ple check the appropriate box of the license for which you are applying. Fifl in the corresponding
requirerne or the license type sought.
❑ Quota Alcohalic B ge License ❑ Specialty Alcoholic Beverage License (e.g. SRX, S, etc)
❑ Club Alcaholic Beverag ' ense
i'his license is issued pursuant to , Florida Stafutes or Special Act, and as such we
acknowledge the fallowing requirements mu met and mainfained:
Please initiat and date: �
Applicant's Initials Date
Auth. 69A-6.0'!0 & 67A-b.056, FAC 6
_ '.: SECTfON 8:= DISCLOSURE OF IN7ER£STED PARTIES.:::.;: ;_;:-°.° ;``>'_.;;`�'. ' � �: ::`::�=°�
Note: Failure io disclose an interest, direct or indirect, could resu[t in denial, suspension and/or revocation of your license.
You MUST list atl persons and entifies in the entire ownership structure. To determine which of those persons
must submit �ingerprints and a Related Party Personal Information, sheet, see the flngerprint section in the
ap �ication insfructions.
Business Name (D/BIA) ���
C�tea�nA
1. When applicat�le, compiete the appropriate section below. At�ach extra sheets if necessary.
7itle/Aosition Name Stock °/a
CORPORATION— List alI officers, directors, and stockhdders
Ir�ra\ �" �O �
GENERAL PARTNERSHIP — List all enaral artners
LIMITED LIABILITY COMPANY— List all man ers meinber & norrmember , drectors, officers, and members
LIMITED PARTNERSH[P — List all enerai and limited artners.
LIMITED LIABILITY PARTNERSHIP — Lisf ali artners
Bar Manager (Fraterna) Organizations of Nafional Scope only):
O7HERINTERESTS
These uesfians must be answered about this business for eve erson or entit fisted as the a licant
1. Are there any persons or entities not disclased who �ave loaned money to the business? ❑ Yes �[, No
2. Are there any persons or entities noi disclosed tha# derive revenue from the license solely
through a contractual relationship with fhe licensee, the substance of which is not related to the ❑ Yes � No
control of the sale of alvoholic bevera es or is exem t b statute or rule?
3. Are there any persans ar entit�es not disclosed that have the right to neceive revenue based on � Yes '� No
a contractual relakionship related to the control of the sale of alcoholic beverages?
4. Are there any persons or entities not disclosed who have a right to a percentage payment from � Yes No
the roceeds of the business ursuant to the lease?
� 5. Are fhere any persons or enti#ies not disclosed who have guaranteed the lease or loan? ❑ Yes fVo
6. Are there any persons or entities not disclosed who have co-signed #he lease or loan? ❑ Yes �10
7. {s fhere a management contract, franchise agreement, ar concession agreement in eannection � Yes �to
with this business?
8. Have you or anyone listed on this applica#ion, accepted money, equipment or anything of
value in connection with this business from any industry member as described in 69A-1.010, ❑ Yes � Na
Florida Administrafive Code?
If yau answered yes to any of the above questions, a capy af the agreement must be submiried with this
appficatlon. The terms of the agreement may require the interested persans or parties related to an entity to
submit fingerprtnts and a related party personal informatlon sheet.
Auth. fi1A-5.010 8 63A-5.056, FAC 7
� SECTIt?N 8- AFFIDAVII' OF APPLICANT
N07ARIZATION REQUIRED� �_.
Business Name (D!B/A}
°I,�the undersigned individuaNy, or on behalf of a legal entity, hereby swear or affirm that 1 am duly authorized to
make the above and foregoing applicatian and, as such, I hereby sw�ear or affirm tha# the attached sketch is a
true and �orrect represehtation of the entire area and premises to be licensed and agree that the place of
business, if licensed, may ba inspectet! and searched during business hours or at any time business is being
conducted on the premises without a search warrant by afRcers of the Division of Alcohoiic Beverages ant�
Tobacco, the Sheriff, his Deputies, and Polfce t3�cers for the purposes of deterrriining c�mpfiance with the
beverage and retail tobacco laws,'
"I swear under oath or affirmatian under penalfy ot perjury as p�ovided for in Sections 559.791, 562.45 and
837.06, Florida Sfattrtes, that the foregang ir�fom�af:on is #rue and that no other person or endty except as
indicated herein has an interest in the alcoholic beverage Iicense and/ar tol�acco permit, and all of the abave
listed persons or entities meet the qualifications necessary to hdd an interest in the alcohoFic beverege licsnse
andlor tobacco perrnit'
STATEOF �i��t a�`
COUNTY Ofi �a I m '�ca. CYl COti► �^ �`�
__ �m.� +lY1 • p�qe10
APPUCANT/ UTH�RIZED R RESENTATIVE�NAME
APPLICA /AU ORIZEO R RESENTATiVESfGNA7URE
The for oirtg was (} Swom to and Su scribed QR () Acknowied before me this �J Day
of 20 I�BY � who is ) personally
(print n�me ) of person( making statement}
known to (} who produced as i8entfication.
Commission Expires:
otary Pu 'c
tHt�iifiFl�P
``��� d ���......,���,4f�1/yi
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• � , e� ,
= = �� °•� �► . �=
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i (� • � �� �
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, � /'O �` ��' •� �t�` \``
�E+ �,� . :�_
Auth. b1A-6.010 � B1A-5.056, FAC 8
;�.. -...;<;. :
,:.. ..,... : : ., : .. :t�<;�€�.;'-`.:�:��_ =�'��'=:;:°;`.°: =:` '�':.
_�,'. . . . • . ..i: _ _
- •-•• �if � . . ..... _ _
. .... -":... ..... '�v.: a�":_�
v'i .
.1_:... . . . . . ... , -'.._.:�t..��:. ,}Y 4.. - _ _ _ _
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... .'�..
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.e
... . .� ... .. . ::.. .... ...:.a �..:':
�..�..-._.-.:`::-�.:.�._.::.:.. �.:...i �.....
This section is to be completed far all current aicvholic beverage andlor tobacco license holders listed on the
a lication to ensure the most u to date information is ca tured.
Business ame (D/B/A)
Last Name First M.I.
Current Alcohal Be�erage and/or 7obacco License PermiUNumber(s)
Date of Birth `-� Social Security Number*
Street Address �
City � State Zip Code
Last Name First M.I.
Current Alrx,hol Beverage and/or To acco License PermiftNumber(s)
Date af Birfh Sociaf Securify 1Jumber"
Street Address
City State Zip Code
Last Name First M.I.
Current Alcoho( Beverage and/or Tobacca License �miUNumber(s)
Date of BirtF� ocial Security iVumber'
Street Address ,
City State Zip Code
l.ast Name First M.f.
Current Alcohol Beverage andlor Tobacco License PermitlNumber(s
Date af Birth Sacial Security umber*
Street Address
City Stat Zip Code
Last Name First M.I.
Current Alcohol Beverage and/or 7obacca License Permit/Number(s)
Date of Birth Social Security Number"
Street Address
City State Zip Code
Auth. 61A�.010 & 61A-5.056, FAC 9