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Home My Public Portal AboutMonahan & Sons4TV -�r Tfi F Tri' fl 1; ;i ?r !JD,r I I HIM CITY OF TYBEE ISLA Q711 3/01/2021 .;``5 '' 13000 Business License CONTRACTOR REGISTRATION -Ens: 001 ;EN, 1424 APPLICATION TFNDFRED: Business Name et\ONA1iRN # SoNS 3 TIV G • Location 13 S tot• e usA Cba+ , ' _LL-i 3Eu,. GEoRcsAA 3 1301 3 Mailing Address 9 3 GaLsZnIAIN kloily su 0s.. ' Gunkoiet 3130.1 1 Phone y'18 - a14 - al sri Email s .r,<,:ciG►r 4a) gr•►t. . c.ogn Federal ID # I 1_ a3 44119 NAICS Code Business Type (circle one): Sole Proprietor Partnership Corporation LLC Other: Type of Contractor 0 General ❑ Electrical 0 Mechanical 0 Plumbing Has this business or anyone connected with this business been cited Federal Law, Local Ordinance, or any Rule or Regulation of the State the City or County within the past 12 months? (circle one) YES o Other C11.a.c.H INSTPrLL-ER. or charged with any violation of Georgi Law, nue Commissioner or any Rule or Re ation of (If YES, list details) 1. Include a copy of your local business license. 2. Any business that requires state licensing must include a copy of state license. List person(s) authorized to request inspections: CN.Wr LLES NCB , AN) ( VAVrf ) , ., } I hereby make application to the City of Tybee Island for a Contractor Registration. I certify that the above statements are true and correct. I understand that the processing fee of $20.00 is non-refundable. I further understand that the provision of false information on this applica may result in the revocation of this registration by the City of Tybee Island. Applicant Signature Date a Ja31a l Printed Name elks r( .Q 1. i�*.al CN KeG1 L .b -et"tL QV. Received by Date ROUTING APPROVAL BY DATE FEE Administrator REQUIRED Contractor Registration 20.00 Zoning Approval REQUIRED Reason fir denial: City of Tybee Island 403 ButlerAvenue Attention: Contractor Registration, P.O. Box 2749, Tybee Island, Georgia 31328-2749 Telephone (912) 786-4573 FAX (912) 786-9539 www.citvoftvbee.orq City of Tybee use only:: Date New Renewal ? License # �q DO()' ? g7c-- License # 2 - QD3q q Affidavit Verifying Status for City Public Benefit Application By executing this affidavit under oath, as an applicant for a City of Tybee Island, Georgia, Business License or Occupation Tax Certificate, Alcohol License, Taxi Permit, Contract, or other public benefit as referenced in O.C.G. A. Section 50-36-1, the undersigned applicant representing TP.014 141144 t"San6,Z.NC. • (name of business), verifies one of the following with respect to my application for public benefit: 1) ✓ I am a United States citizen. (document example: Driver's license, US Passport, US Military Card, etc.) OR 2) I am a legal permanent resident of the United States (document example:1-551 Permanent Resident Card, Certificate of Citizenship, etc.) 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: (document example: Temporary Resident Card; Employment Authorizal fft Card, etc.) —The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least on secure and verifiable document, as required by O.C.G.A. § 50-36-1-(e), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: E3Enn Qt tx % QUM `16EASE In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, Fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and Face criminal penalties as allowed by such criminal statute. Signature of Applicant j 31a) Date++ // ,,^-CS sto `_ Printed Name 0‘,11tiltt!///l/ .4sHA 0 ,,ii t. •••••••••'E% -.„•!.,014% 04,4%. *Rol 1m= •rA 07 tnm•: .. i0 :• z ,,fit" ! PU (� _ BED AND FS RN BEFORE ME ON 20 THIS !!i`1 Notary Public 4 My Commission Expires: PLEASE COMPLETE THIS AFFIDAVIT AND SUBMIT A COPY OF THE IDENTIFICATION DOCUMENT (front and back) PRESENT IN PERSON AT 403 BUTLER AVE OR FAX TO 912-786-9539 OR E-MAIL TO: Ischaaf(a,,cityoftybee.org REFERENCE YOUR BUSINESS LICENSE NUMBER IN THE SUBJECT LINE OF YOUR E-MAIL_ If fax or email this form, please have this form notarized prior to submitting it to the City of Tybee Island at Ischaaffcityoftybee.org or 912-786-9539. The City of Tybee has a notary, if submitting in person. Note: D. C. G.A. § 50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their alien registration number. Because legal permanent residents are included in the federal definition of "alien", legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below: BRYAII COUNTY Phone: (912)653-3892 License Id: 21-00344 Effective Date: 01/01/21 License Type: BUSINESS LICENSE Business Name: MONAHAN & SONS INC Business Location: 73 SADDLEBRUSH ROAD MONAHAN & SONS INC JOHN MONAHAN SR 73 SADDLEBRUSH ROAD ELLABELL, GA 31308 Summary of Services: Description BUSINESS LICENSE Issued Date: 12/16/20 Expiration Date: 12/31/21 NON -TRANSFERABLE TO BE PLACED IN A CONSPICUOUS PLACE License Id: 21-00344 Effective Date: 01/01/21 License Type: BUSINESS LICENSE Business Name: MONAHAN & SONS INC Business Location: 73 SADDLEBRUSH ROAD MONAHAN & SONS INC JOHN MONAHAN SR 73 SADDLEBRUSH ROAD ELLABELL, GA 31308 Summary of Services Description BUSINESS LICENSE Issued Date: 12/16/20 Expiration Date: 12/31/21 2021 2021