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EDtj "T F IV <br />9V r1NY IS4FJ' TEMPORARY USE/STRUCTURE AP LICkQU <br />eF §265-14 <br />JAN <br />'I <br />A licad # <br />D e Rece ved <br />ZQi� �`- <br />yF s9�• FLOR\ 54' Ini �. <br />C, ASO � ;,. :� <br />�Y OF SU�� P <br />City of Sunny isies Beach. ._........ <br />1. Proposed Project Name: /—,As k ! In ,S <br />2. Name of ADDlicant �-bA C''ala <br />a. If applicant is the owner give name exactly as recorded on deed. <br />b. If applicant is lessee, attach copy of valid lease and Property Owners Sworn -to -Consent. <br />C. If applicant is a corporation, partnership, limited partnership, or trustee, a separate <br />Disclosure of Interest form must be completed. <br />d. The property owner and/or applicant hereby waive, release, indemnify, hold harmless, <br />and forever discharge the City of Sunny Isles Beach from any and all claims, losses, <br />demands, contracts, expenses, cause of action, lawsuits, damages and liabilities, of <br />every kind and nature, whether known or unknown, in law or equity, liability as to <br />any claims that may arise from this application. <br />3. Applicant Mailing Address PQ R o)!� j Cj <br />City zu-, a- i e.e, �.-�, State F L Zip 33 0 t h <br />Tel. # (during working hours) ',10 S ~ 6(S - 8+X.0 Other <br />4. Name of Property Owner C.AA dw l L,&;?ev, k 5soc. to -44_ - j. <br />Mailing Address e6 C3 p4 ('4'!? '$ <br />City 44 L '_k 2 C'_k State F C. Zip 3 <br />Tel. # (during working hours) S (a -5 `6 g 5 6Ob O Other <br />5. Contact Person <br />Mailing Address o(..) to <br />City ' � !n State ' FC_ Zip_ 3 � 14 U <br />Tel. # (during w rking hours) q al q T J '74"- Other <br />4. LEGAL DESCRIPTION OF THE PROPERTY COVERED BY THE APPLICATION <br />a. if subdivided, provide lot, block, complete name of subdivision, plat book and <br />page number. <br />b. if metes and bounds description, provide complete legal description (including <br />section, township and range). <br />c. if separate request apply to different areas, provide the legal description of <br />each area covered by a separate request. <br />d. attach a separate, typed sheet if necessary. Verify the legal description is <br />correct. <br />s. . <br />City of Sunny Isles Beach Planning and Zoning Department <br />r0) -.obe'o <br />