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Home My Public Portal About200_BusApplNickiesBar D 1438 Neu.) OermE 0A4-rise 6 ,L /de(, Date A 4 New I l itt CITY OF TYBEE ISLAND Renews/ BUSINESS LICENSE APPLICATION License w l Alcohol License Y or N r k Teu a-nO.''. Entertainment App, Y or N Business Name Location l i `3 d OT LEP AV Mailing Address b •-F. r 1 1 1 c A J .r 04 Phonee4 ca..',/ q ib U ur 1 ...4 1 Email k 40,5 Fion Et i t Federal ID 4:41 i.i..) I 'rt i% 4-7 'I Sales Tax I NAILS Code �f�rr' L3.i. Sri t=- I €'.Gi &;1: r Business Type (circle one, o Proprietor Partnership Corporation LLC Non Profit Other: Names and Home Addresses of Owners, Partners or Corporate Officers Names 1 Home Address I City, State, Zip I Title iA >uaOrrt:Tr)D0 t,nr l CJ.: lit? PIRA'rr .w ::-CI I G,..14 1 I 143� 1 1 I Describe the business you would like to license: '1=jLait SAL- A OD 16S vt1; hi Pt tqfl. 1.1 Lr) p G ii..41..J5 Has this business or anyone connected with this business been cited or charged with any violation of Georgia Law, Federal Law, Local Ordinance, or an Rule or Regulation of the State Revenue Commissioner or any Rule or Regulation of the City or County within the past 12 months? (c,rcie one) YES o -NM) (If Y include details) l lA ing off premise (bills Will your business require signage off premise? tJ Z.' 32 sq ft (4 x 8) z-..-• ft (12 x 16) $100 128 75 288 sq ft 125 Any business that requires state licensing must present state license when applying. It is the applicant's responsibility to ensure zoning conformance. If there is a question as to whether the location is zoned correctly please contact the City Marshal at 912- 786 -4573 x 104. See the reverse side for further instructions and schedule of regulatory fees. Application for alcohol license requires a separate form and approval. Application for live entertainment requires annual review and approval. Applicant Signature A 1 1.4 m Date mot' J Printed Name AL ~i( (5 Q bDfl M.D 11.C2 l ii Received by Date ROUTING APPROVAL I r) BY DATE I FEES City Manager Administrator REQUIRED I a. !MA.. z( in 11 1000 Occupational Tax 125.00 Zoning Approval REQUIRED I I 1 9999 Administration Fee 10.00 Health Dept Certificate Required YES or NO I I I Signage Fire Inspector Certificate Required YES or NO Insurance Policy Required for YES or NO Police Chief Recommendation Required I YES) r NO P P I 12' l't- /l City Council Approval Required I YES or NO I I TOTAL DUE WITH APPLICATION Reason for denial: 403 Butler Avenue, P.O. Box 2749, Tybee Island, Georgia 31328 -2749 (912) 786 -4573 FAX (912) 786 -9539 www.citvoftvbee.ora 3qg- 00 3 BUSINESS LICENSE INFORMATION Every business in this city or doing business or engaged in business within the city is hereby required to have a business license from the city for the privilege of engaging in a business, profession or occupation within the corporate limits, unless city licensing is prohibited under state law or the activity is exempted by this Code. Upon opening for business, a health inspection is required for any business that has ice or food service. An inspection can be set up with Chatham County Health Department at 356 -2893. Also, cooking requires an inspection by the County Fire Inspector at 201 -4306. If any renovations are to be done, a building permit is required. If there are any questions concerning the above permits required, the Applicant can make an appointment to see someone in the Building Zoning Department for more information. Registration of Contractors: Any Contractor working on the island must complete a Business License Application form. The owner must present a current Business License and any State License held to be copied for the file. The fee for a registered contractor is $20.00. The occupational tax is not required unless the Contractor does not hold a business license from another jurisdiction. Regulatory fees are charged as follows, please include if your business falls under the following classifications: LICENSE CLASSIFICATION I FEE J,Occupational Tax (Business License Fee) 125.00 Administrative Fee 10.00 Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited 350.00 Retail Beer /Wine Sale by Drink for Consumption on Premises Only 575.00 J Liquor Sale by Package Only, Consumption on Premises Prohibited 850.00 Retail Liquor Sale by Drink for Consumption on Premises Only 1,250.00 Retail Liquor Sale by Package Drink both in One Building under One Ownership 2,000.00 Sunday Sales of Alcoholic Beverages 150.00 Wholesale Beer 765.00 Wholesale Liquor 1,500.00 Wholesale Wine 150.00 Distiller, Brewer, or Manufacturer of Alcoholic Beverages 300.00 Special Event Public or Private Property Beer, Wine (no current license) per event 50.00 Special Event Public or Private Property Beer, Wine (no current license) 3 days 100.00 Special Event Public or Private Property Beer, Wine (holding current license) per event 10.00 Special Event Business Property Beer, Wine, Liquor (no current license) per event 50.00 Special Event Business Property Beer, Wine, Liquor (no current license) 3 days 100.00 Special Event Business Property Beer, Wine, Liquor (holding current license) per event 10.00 Advertising Bench, per bench 25.00 Amusements, Itinerant (Circus, Camival) $75 per day $600 maximum Beach Equipment, Beach Vehicle, and Water Craft Rental, per site 300.00 Bondsman 165.00 Book Magazine Canvasser, registration fee 45.00 Contractor Registration Fee (Building Construction Contractors, Subcontractors and Tradesmen, licensed in another jurisdiction) 20.00 Escort 500.00 fr ...-1 Entertainment License 50.00 Insurance Sales 40.00 Massage therapist other miscellaneous health practitioner 250.00 Promoter Special Events, Pageants, Festivals, Exhibitions, Sporting Events, Shows, per Single Event 50.00 Transient Merchant, per day 75.00 Transient Rentals, Registration Fee 45.00 Vendor, Festival Hawker, per day 25.00 Vendor, Arts Crafts, per event 25.00 Pedicabs for hire 100.00 Taxi, Touring Vehicles 100.00 CITY OF TYBEE ISLAND 3i ALCOHOL LICENSE APPLICATION it Application is hereby made for a license to do business within the City of Tybee Island as a dealer in alcoholic beverages as indicated below: LICENSE CLASSIFICATION I FEE CHECK Notice: The applicant Retail Beer /Wine Package Sales Only, Consumption on Premises Prohibited 350 I for a license shall be a citizen of the United Retail Beer /Wine Sale by Drink for Consumption on Premises Only 575 I States, a resident of Retail Liquor Sale by Package Only, Consumption on Premises Prohibited 850 Chatham County, and Retail Liquor Sale by Drink for Consumption on Premises Only 1,250 I owner of the business Retail Liquor Sale by Package Drink both in One Building under One Ownership 2,000 I or if a corporation, Sunday Sales of Alcoholic Beverages 150 v; partnership or other Wholesale Beer 765 legal entity is the Wholesale Liquor 1,500 owner, a substantial Wholesale Wine 150 and major stockholder Distiller, Brewer, or Manufacturer of Alcoholic Beverages 300 or the applicant may be Special Event Public or Private Property Beer, Wine (no current license) per event 50 the manager of the Special Event Public or Private Property Beer, Wine (no current license) 3 days 100 business charged with Special Event Public or Private Property Beer, Wine (holding current license) per event 10 the regular operation of Special Event Business Property Beer, Wine, Liquor (no current license) per event 50 said business on the Special Event Business Property Beer, Wine, Liquor (no current license) 3 days 100 premises for which the Special Event Business Property Beer, Wine, Liquor (holding current license) per event 10 license is issued. Business Name fJhC il:_ti__ y 1Li pat) n 1:43 e1.� Location WI Guir tr 0_ A,V "'C isrr, 'm i )i) a-P+ -a t 1 e.x 1 Mailing Address lk os a AID -Pat; "TY e,'[.P :-ice; LAC t5 C.� '3. i 3 n, Phone Cii1_` -la%: +4 -'ti Email 1 i pza_Ab OD Gtil_pur�- 1sic)E s Names and Home Addresses of Owners, Partners or Corporate Officers with Ten Percent (10 Interest in Business Names (attach additional pages if necessary) Date of Birth Home Addresses City, State, Zip I Social Security WO C. ciLL.414kilVa. U., ,P ;"r, -t Vip. r. A 1-1,1 it to Ifff a�.ILIVI i.S AstI)PD e..- eitiAt 7N 41.. Z-A. 1 A$2- -49-- ib"(iacS 1 I I Is business incorporated? ki iL> State of Incorporation is) IA Date Incorporated )'A Names of landlord of the business location Ai 1 CV_ 1:31."xA/.1.IR t,i2. Address 'P.P. lei I»_ M Phone" 'A—I `-k1 -4"1 What other business is conducted at this location? i_ ��fie LAND, 404 "3 1C5 Has application been made for required State and Federal Licenses? NC7I �="Z' Has applicant, any person connected with, or any person having an interest in this business: o ever been convicted of any violation of law other than for a traffic violation o ever served time in prison or other correctional institution? M t o ever had an alcohol beverage license suspended or revoked at any time in any location? kJ I> (if answer is yes, give details) ?J 1*\ If this application is for RENEWAL of an existing license, enter License Number of existing license i■1;% If business is an eating establishment, are SUNDAY sales of alcoholic beverages contemplated? `C •If yes, submit additional affidavit. ALL OF THE FOREGOING INFORMATION IS HEREBY GIVEN AND ALL OF THE FOREGOING STATEMENTS ARE HEREBY MADE ON OATH WILLFULLY, KNOWINGLY, AND ABSOLUTELY, ,AAND _THE SAME IS AND ARE HEREBY SWORN TO ME TO BE TRUE UNDER PENALTY OF LAW. Applicant Signature 1 """""'bate 1) 1 I Approval //J Sig a rge pate /D f ZD/ 1 City Manager I 1.4,,,„,,,, j jS �l Sworn o,d subscrib �fr�r a this day of I Zoning 1 Police I K1 f k I f '/I I I City Counci 1 U !J 1 I Not s. bli v ORGE B. BABGER3 Notary Public, Chatham County, CA Wiy eernmisslon Expires July 5, 2011 The CONSENT FORM is required for ALL alcohol license applications. i CONSENT FORM r;;,° I HEREBY AUTHORIZE THE TYBEE ISLAND POLICE DEPARTMENT TO REQUEST ANY CRIMINAL BACKGROUND HISTORY RECORD ;;`.a INFORMATION PERTAINING TO ME WHICH MAY BE IN THE FILES OF ANY STATE OR LOCAL CRIMINAL JUSTICE AGENCY. BE IT FURTHER UNDERSTOOD THAT THE PURPOSE OF OBTAINING THIS INFORMATION IS TO SATISFY THE REQUIREMENTS SET FORTH BY THE MAYOR ,S AND COUNCIL OF THE CITY OF TYBEE ISLAND, REGARDING AN ALCOHOL BEVERAGE LICENSE APPLICATION. M ,A.1 uq- in —laG Z.' A�� D v la. �oto �o Mats SEX RACE DATE OF BIRTH e FULL NAME (PRINT) .1 k o R fl.1" ri u; ,r, z r :°a s. 's.V i,7 'f i „C L ADDRESS SOCIAL SECURITY NUMBER r CO 1 ,:t., :I�VJlNPJ- i= 1 �'Y« -1 l CITY, STATE, ZIP SIGNA URE DATE The ACKNOWLEDGEMENT is required for all LIQUOR BY THE DRINK alcohol license applications. ACKNOWLEDGEMENT I declare knowledge and understanding of Municipal Code Section 58 -80: There is levied an excise tax on the sale of distilled spirits by the drink in the amount of three percent of the charge to the public for the beverage. SIGNATURE DATE The AFFIDAVIT is required if SUNDAY SALES of alcohol for consumption on premises are contemplated. Food and beverage sales records prepared by a CPA are required to be furnished to the City upon request. STATE OF GEORGIA COUNTY OF CHATHAM CITY OF TYBEE ISLAND AFFIDAVIT I, A 1L �A xi i]s= i? -fp t n iv"Nt; 0 i ,c iLi. do hereby make this affidavit to be part of my application for an alcohol beverage license in the City of Tybee Island to sell distilled spirits, malt beverages and /or wine for the consumption on the premises in my eating establishment on Sunday. Said establishment is located at k 5" i3 "i30 EW Tybee Island, Georgia. I am the p i h) of the establishment known as t t tt Z tt=ea latlf3i AKi6 Lj tLL- I hereby further state that at least fifty percent (50 of the total annual gross food and beverage sales are derived from the sale of prepared meals or food. 0 4 9 4 44 4>1.-e ":1: '1 :..:2 JA40 SIGNATURE DATE I 11 Approved Denied �/1 Chief of Poke PP Date t 1t5F 1 H CITY OF TYBEE ISLAND ENTERTAINMENT LICENSE APPLICATION Business Name N l iC. i 7� wcaz.. 1L .p n 4; CO i. Location tiao 7`i 12 AV 5. 'T+ O C i._4. D A Mailing Address lP L7f�1L1 4i1 iy aFs LA c_ Phone 44414 I Email Federal ID i4 PC>i _-ii I Sales Tax ID lPi ,Vl Fi7 I NAILS Code 14- Business Type (circle one) o e roprielor) Partnership Corporation LLC Non Profit Other: Names and Home Addresses of Owners, Partners or Corporate Officers Name 1 Home Address I City, State, Zip I Title R i. �iJj a_ T[C D D ti2. l a. t 1/5.9 e) MTN <_:.11'V AR .4.)111 C>iP iZ 1 1 1 An establishment selling alcoholic beverages and desiring to provide live or recorded amplified music for the entertainment of its customers shall obtain an entertainment license from the City. An application for an entertainment license shall be made to the city manager in the name of the business establishment. The annual fee shall be $50.00. This license is renewable on an annual basis on or before each December 31. A late penalty of 10% shall be assessed for a license payment made after April 1. An establishment is exempted from the requirements of this section if the amplified recorded sound derives exclusively from either a jukebox, a radio, or a digital music system supplied to the premises by a cable television company under the franchise of the City. i Ji Applicant Signature 1 1 diA.Ark !r v 'w Date 1 /c� 1 Printed Name pri_wpa:i') •-c^vvt) Received by Date 0 /1 ROUTING APPROVE OR DENY BY DATE FEE City Manager I I 1 9926 Entertainment License 50.00 Zoning Administrator Police Chief TOTAL DUE WITH APPLICATION Reason for denial: 403 Butler Avenue, P.O. Box 2749, Tybee Island, Georgia 31328 -2749 (912) 786 -4573 FAX (912) 786 -9539 www.citvoftvbee.ora Affidavit Verifying Status 4 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, I am stating the following with respect to my application of a City of Tybee Island: Business License or Occupational Tax Certificate, Alcohol L (circle all that apply) Taxi Permit, Contract Other public benefit for ,N L1,--4.Aki AL it_ —C p6 r) i t; i),S S L"' Ne (printed name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity). 1) v I am a United States citizen. OR 2) I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non immigrant under the Federal Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States. 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 Code Section 16 -10 -20 of the Official Code of Georgia. Signature of Applicant 2 1 Date A /e44 er- 7,c.,( {MO".-•,, s3 Printed Name Alien Registration Number for Non citizens SUBSCRIB D AND SWORN BEFORE ME ON THIS THEJ DAY OF Feb r eA C r7 20 Notary Public GEORGE BA N My Commission E res V e u u iy r k s ft?ics: 7 K Note: O.C. C.A. 50- 3d-Y(e that aliens unde 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: 4 I 4 ffU( TSMRg- SUNDAY SALES OF ALCOHOLIC BEVERAGES Business Name el.A Location of Business t h i'`h C.j .a•.fs V r For annual renewal of a For Period Beginning 20 Sunday Sales license, provide month day year one year of data, beginning with the most recent full Through Period Ending 20 month and including the month day year eleven months previous to it year eleven OF GROSS RECEIPTS TOTAL GROSS RECEIPTS Food w Alcoholic Beverage Total Gross Receipts 100% I certify under penalty of perjury that this is a true and correct report. Signature of Certified Public Accountant Printed Name of CPA e' 04,4c.4 CPA Telephone Number of CPA q, 2 7' L D k Georgia State License Number of CPA 3,31/5 G A cL Form received by on 20 Approved/ Denied (circle one) by 017 20 P.O. Box 2749 403 Butler Avenue, Tybee Island, Georgia 31328 -2749 (912) 786-4573 www.cityoftybee.org NEI" 4 f c,i th i ra Y7f( y