5910 S Dixie Hwy Liquor License_2014STATE OF FLORIDA DBPR Fonn
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ABT-6001
Revised 08/20141
If you have any questions or need assistance in completing this application, please contact the Division of
Alcoholic Bever. i ' a Tobacco's • i T) local district office. Please submit I i ! ' ' !i application
t required to your local district office. ! i be submitted by 'r !
appointment, or be dropped off t District Office Address ! Contact Information be
found on AB&T's web site at the linkprovided beloW
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Rugg
jaldhs4or details
Contact Person
Telephone Number
VECTOR D RODRIGUEZ
3058041047
ext.
•i•; =
Mailing Address (Street or P.O. Box)
5910
city
SOUTH MIAMI
i
Auth. 61A -5.010 & 61A-5.056, AC 1
Ma •r*
,
ABT District Office Received Date Stamp
are a current licensee.
Business Name (D/B/A)
SOUTH MIAMI CIGAR & WINE
2� Full Name of Individual
OSE MANUEL GARCIA
Social Security Number*
Home Telephone Number
Date of Birth
264714857
7816 4574169
03 251962
Race
Sex
Height
Weight
Eye Color
Hair Color
White
Male
5-06
175
GREEN
BROWN
3, Are you a U.S. citizen?
Z Yes [:1 No
If no, immigration card number or passport number:
Auth. 61A-6.010 & 61A-5.056, FAC 2
known ► me OR who produced • r
. . .... . ... .. ...... .
_M.r.
Commission Expires:
Auth. 61 -5.010 & 61A-5.056, FC
0
Aufh. 61A-6.010 & 61A-5.056, FAC
'01 swear under oath or affirmation under penalty of k-j6ri ii 6rovided for in sections 559.791, 562.45 a
837.06, Florida Statutes, that I have fully disclosed any and all parties financially and or contractua
interested in this business and that the parties are disclosed in the Disclosure of Interested Parties of t
application. I further swear or affirm that the foregoing information is true and correct." I
Commission Expires: -------
111 ! �
Auth. 61A- 5.010& 61A-5056, FAC 3
Type of Offense
Au, 61A -5.010 & 61- 5:056,
tislolIEW114101 =Btu 11AINAW-WAW, I
Commission Expires.
Auth. 61A- 5,010& 61A-5.056, FAC
QA v C2
r
u -5.01 61A-5-066, 4
Business me •
I the undersi • -r inclividuall • r on - of -• eb swear or dul authorized r
••. i �-• • '• • 1HW4&M • - s •• - • •- - • •r r
Leal
Commission Expires�
61A-5.010 F
F4:° Z:UIRR'VE-14T LICENSEE UPDATE DATA SHEET
I his section IS TO De compieted Tor an current aicohoiic Deverage andior tobacco license holders listed on the
11 app is to ensure the most o date Information s a rea.,
Business Name (I /A)
SOUTH MIAMI CIGAR & WINE
Last Name First
M. 1.
Current Alcohol Beverage and/or Tobacco License Permit/Number(s)
Date of Birth Social Security Number*
Street Address
City
State
Zip Code
Last Name First
M.l.
Current Alcohol Beverage and/or To acco License Permit! uber(s)
Date of in
Social Security Number*
Street Address
City
State 71
Zip Code,
Last Name First
M. 1,
Current Alcohol Beverage and/or Tobacco License Perm it/ N um ber(s)
Date of in Social Security Number*
Street Address
City State
Zip Code
Last Name First
M.L
Current AlcohG1 Beverage and/or To cc License Permit/Number(s)
a i
Dte of Brth
Social Security Number*
Street Address
City
State
Zip Code
Last Name First
M. 1.
Current AlcoW61 "Beverage and/or Tobacco License Perm it/ N umber(s)
Date of Bi
Social Security Number*
Street Address mm
Auth. 61A-6.010 & 61A-5.056, FAC 9
r-OMM
COMPREHENSIVE LA AMENDMENT
($5,000)
001.0000.219.1610 Advertisement and Notice Fees .... ...............................
($1,500)
001.0000.341.2000 Admin Fee ........... ............................,,.
($28,500)
001.0000.341.3000 TEMPORARY STORAGE UNIT (PODS)
( $ 30,000)
DRI (DEVELOPMENT F REGIONAL ACT)
APPLICATION FEE ...... ...............................
($25,000)
PLUS RESIDENTIAL PER SQ. FT. GFA.........
($0.075)
PLUS NON-RESIDENTIAL PER SQ. FT. GFA -.;.,
($0.10)
PLUS MIXED USE PER SQ. FT. GFA ...............:
($0.10)
DRI (DEVELOPMENT F REGIONAL IMPACT)
($150)
SE 360 EXEMPTION REQUEST .....................
($25,000)
PLUS RESIDENTIAL PER S. FT. GFA.........
($0.075)
PLUS NON-RESIDENTIAL PER SQ. FT. GFA.;..
($0.10)
PLUS MIXED USE PER SQ. FT. GFA .............:...
($0.10)
I (DEVELOPMENT EGI A IMPACT)
SUBSTANTIAL CHANGE
PER SQ. FT. GFA OF AREA OF CHANGE_--
($0.075) -----------
TENTATIVE PLAT .... ...........::::...............:
($5,000)
FINAL PLAT ................. ........................r..;...
($4,000)
WAIVER -OF -PLAT APPLICATION... ... e, . x :. x ....
($4,500)
001.0000.341.3000 TEMPORARY STORAGE UNIT (PODS)
RESIDENTIAL
MAX. SIZE 8 FEET X 16 FEET
PER 14 DAY PERIOD .............::.......::
($50)
NON-RESIDENTIAL
MAX. SIZE 8 FEET X 32 FEET
PER 30 DAY PERIOD ........................
($150)
(If associated with a Building Permit ......No Fee)
White copy to Planning; Pink copy to Customer; Yellow copy 4o Finance