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HomeMy Public PortalAboutSEASIDE SWEETS.pdfCITY OF TYBEE ISLAND SIDEWALK CAFE OR MERCHANDISE DISPLAY PERMIT APPLICATION Business name n— C �✓‘ ! Street address 5 /Y i, rl 54*-- S,�i, (v Mailing address if,/ L.4 4.......( e. r...1 0f1(( ybz 14(n.,a) c 3/32 e Name of business owner: /,y,4 x e,i 5c�� (� Email ;7 r e) �ctl� 56e�5�r 5 lJ7 .41,E Phone numbers of owner: Business /_.7 rHome [f' — Cps 3-Ntxs .." r — Mobile fl y Name of applicant if other than owner: it/Aik Email Phone numbers of applicant: Business Home Mobile Relationship of applicant to owner (same, employee, agent, etc.) Mailing address of applicant Application is for: 171 Sidewalk Cafe ❑ Merchandise Display 1. The length and width in feet of the public right-of-way to be used: 5'I 2. The number of tables and chairs to be provided at the Sidewalk Cafe: 3. Hours of operation of the Sidewalk Cafe or Merchandise Display: Sunday: d'a.M until Monday: until Tuesday: until Wednesday: until Thursday: until Friday: until Saturday: until FOR OFFICE u5E OHLT Date Received New or Renewal License Number Sidewalk elements of cafes and merchandise displays must be secured daily when normal business operations cease. The applicant shall not replace the approved items or change the layout without written authorization from the Planning and Zoning Manager. DOCUMENTS REQUIRED WITH APPLICATION l�J ffidavit (must be notarized; see page 2) Indemnification Agreement (must be notarized; see page 3) Certificate(s) of Insurance listing the City of Tybee Island as an additional insured (see page 4) A Site Plan to scale with measurements of the proposed sidewalk area and all items to be placed on or within it (see page 4) Photograph(s) of the sidewalk area (optional) Applicant's signature Printed name Date ROUTING APPROVE OR DENY BY DATE FEE City Mars= Sidewalk Use Fee $0.00 An application may require 30 days or more to process. DIRECT AN APPEAL OF PERMIT DENIAL TO THE CITY MANAGER Planning & Zoning Manager 403 Butler Avenue, P.O. Box 2749, Tybee Island, Georgia 31328 (912) 472-5033 FAX (912) 786-9539 Lschaaf@cityoftybee.org Page 1 of 6 12/14/2012 AFFIDAVIT Wl GS , acting in the capacity of C n- 'Q. sc,✓��S name 1 owner, agent, employee, etc. on behalf of the establishment known as a s [ -e. 7 (may ac TS located at business name street address , Tybee Island, Georgia, attest to the following: o I have reviewed this application and all entries are correct and accurate to the best of my knowledge. o There are no omissions of fact. o There are no items located on the sidewalk where the Sidewalk Cafe or Merchandise Display is proposed that would prohibit the Planning and Zoning Manager from issuing a Sidewalk Cafe or Merchandise Display Permit. o No violation(s) of Georgia Law, Federal Law, Local Ordinance, or any Rule or Regulation of the State Revenue Commissioner, or any Rule or Regulation of the City of Tybee Island or Chatham County have been adjudicated against this business within the last 12 months preceding the date of the application, or, o The following violation(s) of Georgia Law, Federal Law, Local Ordinance, or Rule or Regulation of the State Revenue Commissioner, or Rule or Regulation of the City of Tybee Island or Chatham County have been adjudicated against this business within the 12 months preceding the date of the application: /11/1/1r o I have read the South End Policies and Procedures and will abide by said South End Policies and Procedures at all times during the term of the Sidewalk Cafe or Merchandise Display Permit. Notarized Signature: Printed Name: STATE OF GEORGIA COUNTY OF CHATHAM The foregoing instrument was acknowledged et! n ctrcl� u Date: 512cb, day who is personally known to me Sign use of Notary Public My Commission expires: /c) ` /.5 — a ef Page 2 of 6 or who has produced identificatio • ► '� •+ +••• '•_� 1,00 TA R s `3 : • 731 Janet R LeViner PUgLiG • 44"i '° '' NOTARY PUBLIC �'•-�T•'•• ;.•'' GEORGIA ••:,' 7COO :•''. Chat Chatham My Commission Expires 10/15/2024 12/14/2012 INDEMNIFICATION AGREEMENT (RELEASE AND HOLD HARMLESS AGREEMENT) This Indemnification, Release and Hold Harmless Agreement is made this ,7(1 day of Ifq\CA ti ,20), ,by 1,60vAiv 07 La.-- ("APPLICANT") for the benefit of the City Tybee Island, Georgia ("CITY"). When refer4d to herein, the CITY means the Planning and Zoning Manager, the municipality, its City Council, and each member thereof, and its officers, employees, advisory board members and representatives. WHEREAS, the APPLICANT is the owner or lessee of the property located at Island, Georgia; and, WHEREAS, the APPLICANT has applied for a Sidewalk Cafe or Merchandise Display Permit for the temporary use of the sidewalk area abutting the property described above pursuant to City Codes, ordinances, and policies and is required thereby to indemnify, defend and hold and save the CITY harmless for its use of the public right-of-way (hereinafter collectively the "PROPERTY"); and, f , Tybee WHEREAS, the APPLICANT is authorized to and has obtained all necessary approvals for this Agreement, NOW, THEREFORE, in consideration of the CITY allowing the APPLICANT to use the public right-of-way for its Sidewalk Cafe or Merchandise Display the APPLICANT agrees as follows: 1. The above recitals are true, and correct and are incorporated herein by reference, 2. The APPLICANT agrees to indemnify and hold and save the CITY harmless from any and all damages, loss or liability occurring by reason of any injury of any person or property which may occur as a result or consequence of the issuance of the Sidewalk Cafe or Merchandise Display Permit or the use of the PROPERTY by the APPLICANT or their family, officers, agents, representative, guests, employees, invitees, or persons contracting with either or any of them or occasioned by an act or omission, neglect, or wrongdoing of the APPLICANT or their family, officers, agents, representative, guests, employees, invitees, or persons contracting with either or any of them. APPLICANT will, at their own cost and expense, defend and protect the CITY against any and all such suits, claims or demands which may be claimed to have arisen as a result or consequence of or in connection with the issuance of the Sidewalk Cafe or Merchandise Display Permit or the use of the PROPERTY by the APPLICANT or their family, officers, agents, representative, guests, employees, invitees, or persons contracting with either or any of them or occasioned by an act or omission, neglect, or wrongdoing of the APPLICANT or their family, officers, agents, representative, guests, employees, invitees, or persons contracting with either or any of them. Notwithstanding the foregoing, this should not be construed so as to require the applicant or anyone else to indemnify the CITY for claims arising from the sole negligence of the CITY, its agents, employees, or officers. 3. The APPLICANT does hereby remise, release, satisfy, quit claim, and forever discharge the CITY from any and all actions, suits, claims or demands that they ever had, now has, or may have in the future against the CITY as a result of the granting of the Sidewalk Cafe/Merchandise Display Permit or because of the use of the PROPERTY by the APPLICANT or their family, officers, agents, representatives, guests, employees, invitees, or persons contracting with either or any of them. 4. The APPLICANT will maintain liability or other insurance as required by City codes, ordinances, and policies which shall name the CITY as an additional insured and for which the CITY will be given a current certificate. Said liability or other insurance shall provide coverage for any suit or claim arising from the issuance of the Sidewalk Cafe or Merchandise Display Permit or the use of the PROPERTY by the APPLICANT. 5. The terms of this Indemnification Agreement shall be binding upon and inure to the benefit of the parties and their heirs, legal representatives, successor :+a . . ssigns. Notarized signature: I_ Printed name: Date: STATE OF GEORGIA COUNTY OF CHATHAM The foregoing instrument was acknowledged before me this (c day of (� �t t*— C-41./ 1 Th de),-) 3 who is personally known to me or who has produced identi Signatut of Notary Public My Commission expires: Page 3 of 6 /c -AS--apt Janet R LeViner NOTARY PUBLIC Chatham County, GEORGIA My Commission Expires ;O!1 CONTACT INFORMATI AGENCY CUSTOMER ID: DB2106211543017 CONTACT TYPE:IRSPECtiOTI Contact CONTACT TYPE: Accounting Contact CONTACTNAME:RACHEL JONES CONTACT NAME: RACHEL JONES P EI 0 HQME El BUS 0 CELL (678)613-4225 IIHECarRY 0 HOME 0 BUS 0 CELL PRB44RY PHONE# ❑NOME ❑BUS ❑CELL (678) 613-4225 8ECONDARY 0 HOME PHONE* ❑Bus 0 CELL PNtMARYE. AILAODRESS 11'BEEGRITS@GMAIL.COM PwMARyEaaaLAODREss:TYBEEGRITS©GMAIL.COM SECONDARY E-MAIL ADDRESS: SECONDARY E-MAIL ADDRESS: PREMISES INFORM &TTOtu /Aft -k Arran ose sue... AJJ:a.-..—_- ---- ,- - - LOC # 1 BLO # 1 STREET 18 B TYBRISA ST CITY: Tybee Island COUNTY: STATE: GA ZIP:31328 DESCRIPTION OF OPERATIONS:RETAIL CANDY & ICE CREAM STORE LOC # STREET CITY LIMITS INSIDE OUTSIDE OTHER INTEREST OWNER TENANT LESSOR # FULL TIME EMPL ANNUAL REVENUES: $ 25,000 OCCUPIED AREA: SQ Fr *PART TIME EMPL OPEN TO PUBLIC AREA: SQ FT TOTAL BUILDING AREA: SQ FT BLD # CITY: STATE: COUNTY: DESCRIPTION OF OPERATIONS: ZIP: CITY LIMITS INSIDE OUTSIDE OTHER INTEREST OWNER TENANT LESSOR # FULL TIME EMPL ANY AREA LEASED TO OTHERS? Y I N ANNUAL REVENUES: $ OCCUPIEDAREA: SQ FT # PART TIME EMPL OPEN TO PUBLIC AREA: SQ FT TOTAL BUILDING AREA: SQ FT LOC STREET BLD # CITY: STATE COUNTY: DESCRIPTION OF OPERATIONS: LOC # STREET ZIP: CITY LIMITS INSIDE OUTSIDE OTHER INTEREST OWNER TENANT LESSOR # FULL TIME EMPL ANY AREA LEASED TO OTHERS? V/ N ANNUAL REVENUES: $ OCCUPIED AREA: SQ FT *PART TIME EMPL OPEN TO PUBLIC AREA: SQ FT TOTAL BUILDING AREA: SQ FT ANY AREA LEASED TO OTHERS? Y / N BLD # CITY: STATE: CITY UMITS INSIDE OUTSIDE COUNTY: DESCRIPTION OF OPERATIONS; NATURE OF BUSINES ZIP: OTHER INTEREST OWNER TENANT LESSOR # FULL TIME EMPL ANNUAL REVENUES: $ OCCUPIED AREA: SQ FT #PART TIME EMPL OPEN TO PUBLIC AREA: SQ FT TOTAL BUILDING AREA: SQ FT ANY AREA LEASED TO OTHERS? Y/ N APARTMENTS CONDOMINIUMS CONTRACTOR INSTITUTIONAL MANUFACTURING OFFICE RESTAURANT RETAIL SERVICE I WHOLESALE I IBU DATEsuseis$s STARTED (MMIDD/YYYY) DESCRIPTION OF PRIMARY OPERATIONS RETAIL CANDY & ICE CREAM STORE RETAIL STORES OR SERVICE OPERATIONS % OF TOTAL SALES: INSTALLATION, SERVICE OR REPAIR WORK .A OFF PREMISES INSTALLATION, SERVICE OR REPAIR WORK % DESCRIPTION OF OPERATIONS OF OTHER NAMED INSUREDS ADOITIONAI LMTIFRFcT Aim. ..it n...1.11 INTEREST ADDITIONAL INSURED BREACH OF WARRANTY CO-OWNER EMPLOYEE AS LESSOR LEASEBACK OWNER LENDERS LOSS PAYABLE REASON FOR INTEREST: UENHOLDER LOSS PAYEE MORTGAGEE OWNER REGISTRANT TRUSTEE $ s all scenarios - provide on y file necessary data) Attach ACORN) 45 for more Additional Interests NAVE AND ADDRESS RANK: EVIDENCE: CERTIFICATE I POLICY $END SILL INTEREST IN ITEM NUMBER CITY OF TYBEE ISLAND PO BOX 2749 TYREE ISLAND GA, 31328 LOCATION: BUILDING: VEHICLE: BOAT: AIRPORT: ITEM rtl AIRCRAFT: REFERENCE/ LOAN #: INTEREST END DATE: ITEM DESCRIPTION ITEM: UEN AMOUNT: PHONE (A/C, No, all: FAX (Ale, No): ACORD 125 (2016/03) E-MMLADDRESS: Page 2 of 4 5ecLi, c(,e. 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