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Temp. Use Permit - Chobee WrestlingCity of Okeechobee 55 S.E. 3rd Avenue Okeechobee, Florida 34974 (863) 763 -9821 Temporary Use Permit Permit Number: 17 -004 Date(s) of Event: June 16, 2017 6:OOAM — 2:00PM Permit Expiration: June 16, 2017 11:59PM Purpose of Request: Barbeque Fundraiser Chobee Wrestling Property Owner: Karla Roby & Debra Sales Address: 1906 SW 5th Avenue City: Okeechobee State: Florida Zip Code: 34974 Applicant: His Church -It's Jesus Church Applicant's Address: 1167 Linda Rd., Okeechobee Phone Number: 863 - 357 -6500 Address of Project: 1600 S Parrott Ave Current Zoning: Heavy Commercial (CHV) FLU Designation: Commercial (C) Subdivision: 1St Addition S Okeeechobee Lots 1 -12 & alley Block 29 Restrictions /Remarks: All debris must be removed upon final completion date. Owner understands and agrees to the following: X Issuance of a permit may be subject to other conditions and time limitations. X Issuance of a permit is not authorization to violate public or private restrictions. X Failure to comply with applicable regulations may result in withholding future permits. X There may be additional permits required from other governmental entities. Applicant's Signature Date: S/ i 6717 ,T c t .eJ D Date: May 16, 2017 General Services Secretary REF: .ORD.716, Temporary Structures CITY OF OKEECHOBEE General Services Department, Room 101 55 Southeast 3rd Avenue Okeechobee, FL 34974 e 863- 763 -3372 ext.217 Fax: 863 -763 -1686 4' ~' ,,,,,.,— :.::'is 4. � _�- " ° "„ "s ';•��,,, DATE RECEIVED: ;� _ f� � . DATE ISSUED: Telephone Numbers: Home: Work: Mobile /Cell::, Pager: Name of Applicant: nI Wag, vC - - -- St c l lx eh. Lyle, DATE(S) OF EVENT: APPLICATION NO: ! 1 �Qa�F 4 (o I i (,1I .1 60 40, - FEE: $175.00 P. L' DATE PAID: ( /4_, )j If Non - Profit/Civic Organization ,v I l d d i this a llcation Is for use by the LI�I L 7- ©q -7Yf+, • TEMPORARY USE PERMIT APPLICATION URES (sEc 668 • AF'LICANT I1 Name of PropertyOwner(s): . pLQ,An 3. <,� c-L 5 Address: i (+ COQ J Pvpo 1 i Ao C, ©i��t= C)JUl E. `/li 7 , Telephone Numbers: Home: Work: Mobile /Cell::, Pager: Name of Applicant: nI Wag, vC - - -- St c l lx eh. Lyle, Address: ti I 1� nc C. f_C Qke , R 340i -74 --0430 Telephone Numbers: Home: WorFC /574,500 Mobile /Cell: Pager: • aOther u.1 0 a, Future Land Use Map Designation: Current Zoning Designation: e f -i V Legal Description of Property: Ai >,� , 5 oKL� c; s i - I)_: t- A "L •! 13 Address of Property: .J (Q no 1A Cr v Il Au L Please Explain Type of Use: B � a F'lt.vl( ( iS_e( • Briefly describe use of adjoining property: East: y North: 1., 1 -. i StrY %i u_-i o 7_ cwt f:. .1` South: OLD c 1, u:. A c� t�, 5 West: a &JL ,,+ /4614 ► . D \ temporary structures subject to the following regulations: 1. Christmas tree, fireworks and similar seasonal sales operated, by a non - profit organization. 2. Carnival, circus, fair or other special event operated by a non - profit organization on or abutting their principal use. " 3. Commercial carnival, circus or fair In commercial or industrial districts. , 4. Similar temporary structures where the period of use will not exceed 30 days a year. The =pplic . hall: for is issued, in the ubmlt proof of liability insurance, paid In full covering the period which the permit minimum amount of $1,000,000.00 per occurrence. ( G�'TK 4 F °�" 2. Remove all debris within 48 hours of expiration of permit 3. Have notarized written permission of property owner, if applicant is notthe property owner. 4. Submit Site Plan * . 5. Submit State inspection Certificates) * 6. Submit State Annual Permit "` I l d d i this a llcation Is for use by the hereby certify that tha information on this application is correct. The Information nc u e n pp City of Okeechobee in processing my request. False or misleading Information may be punishable by aline of up to $500.00 and Imprisonment of up to thirty days and may result in the summary denial of this application. • D 5/9 /(`l Signature of Applicant City Staff (Please review the application, attach comments or special conditions): Occupational and /or State License Verification: -��� Flre Department Approval: Date Police Departm Public Works Department Ap val: Building Inspector Approv- : City Administrator Approval: Aevlsed 211/�a tilt Y6,3- X34 3C43 Date• -s- .5 Apia Datel4 Date: Date:3 ^11- l7 Dater * / / • / 7 Date: //j, -m_. cAlI /Al /goy BRAHMAN THEATER III P.O. Box 1395 Okeechobee, Florida 34973 We give permission to C 1V , to hold a fundraiser on Our property located at 1500 S. Parrot Avenue, on , t I (c , 2017. Said party is responsible for all trash removal for stated event. x Debra S. Sales Owner X Karla H. Roby Owner A z 4—J CD. w 0 0 LL) cC Exempt Organizations Select Check Exempt Organizations Select Check Organizations Eligible to Receive Tax - Deductible Charitable Contributions Pub 78 data) - Search Results The following list includes tax - exempt organizations that are eligible to receive tax - deductible chartable contributions. Click on the "Deductibility Status" column for an explanation of limitations on the deductibility of contributions made to different types of tax - exempt organizations. Results are sorted by EIN. To sort results by another category, click on the icon next to the column heading for that category. Clicking on that icon a second time will reverse the sort order. Click on a column heading for an explanation of information in that column Page 1 of 1 1 -1 of 1 results Results Per Page 2,5 v GK (Doing Business As) 47- 0978467 His Church -Its Jesus Church Okeechobee Return to Search FL United States Prev 1 -1 Next u Prev 1 1 -1 Next https: / /apps.irs.gov /app /eos /pub78Search.do ?ein 1 =47- 0978467 &names = &citv= &state= A11... 5/10/201' x�J" �7���� .,m" rw="� ��� nm~���m`,m,/ x°,,"""y,m", )00548 P.O. BOX 2508 CINCINNATI OH 45201 HIS CHURCH - ITS JESUS CHURCH INC 1167 LINDA RD OKEECHOBEE FL 34974 Employer identification number: Tax form: Document locator number: For assistance, call: Dear Applicant, In reply refer to: 9999999999 5ep, 23, 2014 LTR 3367C SO 47-0978467 000000 00 00024781 BODC: T[ 47-O978467 1023 1/053-253-5U981-4 1-877-829-5500 We received your application for exemption from federal income tax and your user fee navment. During the initial review process, applications for exemption are separated into two groups: 1. Those that can be processed based on information submitted 2. Those that require additional information to be processed If your application falls in the first group you'll receive a determination letter within approximately 90 daps from the date of this notice stating that you re exempt from federal income tax. If your application falls in the second group, you'll he contacted when your application has been assigned to an Exempt Organizations specialist for review. You can expect to be contacted within approximately 180 days from the date of this notice. After 180 days, if you haven't been notified your application was assigned to a specialist, you can contact Customer Account Services Monday through Friday at the toll-free number shown above to check on its status. The individual calling on your behalf will need the following information: * Your name * Your employer identification number (FIN) * The document locator number listed above and assigned to your request * A proper power of attorney submitted with your exemption application, unless the individual calling is an officer or director and legally authorized to represent you The IRS doesn't issue =tax-exempt numbers" or "tax-exempt certificates" for state or local sales or income taxes. If you need exemption from these taxes, contact your state or local tax offices. Most organizations are required to file an annual information return 9999999999 Sep. 23, 2014 LTR 3367C S8 47-0978467 000000 00 00024782 HIS CHURCH - ITS JESUS CHURCH INC 1167 LINDA RD OKEECHOBEE FL 34974 (Form 990, Form 990-EZ, or Form 990-PF) or electronic notice (Form 990-N, the e-Postcard) while their applications for exemption or miscellaneous determination requests are pendino' If vou don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. Visit www.irs.gov and type "annual exempt organization return: who must +iie" in the search box for information on the types of organizations that are required to file annual returns or notices. To receive the Exempt Organizations' E8 Update, an electronic newsletter with information for tax-exempt organizations and tax practitioners, go to www.irs.gov/charities and click on "Free e-Newsletter'" For tax forms, instructions, and publications, visit www.irs.gov or call 1-800-TAX-FORM (1-800-829-3676), Sincerely yours, Tamera Ripperda Director, Exempt Organizations CERTIFICATE OF LIABILITY INSURANCE HISCH -2 OP ID: S2 DATE (MM /DD /YYYY) 05/09/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Pritchards & Associates, Inc. 1802 S Parrott Ave Okeechobee, FL 34974 -6179 Lowell H Pritchard INSURED His Church -Its Jesus Church Inc.aka Buckhead Ridge 1167 Linda Road Okeechobee, FL 34974 NAME: Lowell H Pritchard PHONE 863- 763 -7711 (A/C No Ext): E -MAIL ADDRESS: r FAX 863- 763 -5629 I (A/C NoL INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: First Nat'l Ins Co of America 24724 INSURER B: INSURER C : INSURER D : INSURER E : INSURER F : • REVISION NUMBER: vTHIS1IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY PERIOD TO WHICH THIS ALL THE TERMS, -_ -- ADDLSUBR� � POLICY EFF I POLICY EXP INSR j LIMITS LTR TYPE OF INSURANCE i INSD I WVD'. POLICY NUMBER (MM /DD /YYYY) (MM /DD /YYYY) A , X COMMERCIAL GENERAL LIABILITY ,--- -1- - -° X 101 0181015420 06/26/2016 06/26/2017 CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOCI. _ ! JECT OTHER: EACH OCCURRENCE $ 1,000,000 �$ 1,000,000 l $ 10,000 DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE $ 1,000,000 $ 2,000,000 $ 2,000,000 PRODUCTS COMP /OP AGG I AUTOMOBILE LIABILITY I, _I ANY AUTO ALL OWNED -- NON-OWNED D I I I -, - AUTOS AUTOS ' �,I HIRED AUTOS__ AUTOS ' COMBINED SINGLE LIMIT jEa accident) $ $ $ - -_ - - -- $ BODILY INJURY (Per person) I BODILY INJURY (Per accident) ( )I - - PROPERTY DAMAGE (Per accident__ UMBRELLA LIAB • OCCUR EACH OCCURRENCEI. $ -, EXCESS LIAB CLAIMS -MADE '�, AGGREGATE - -- $ - - - -, RETENTION $ DED WORKERS CO MPENSATION AND EMPLOYERS' LIABILITY AND PER OTH- ,__. E R E L EACH ACCIDENT E L DISEASE EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ , ANY PROPRIETOR /PARTNER /EXECUTIVE N / A • OFFICER /MEMBER EXCLUDED. __ ''�, (M anddtory in and DESs,RIPTIOe under DESCRIPTION OF OPERATIONS below ' $ A Property Section 01C181015420 06/26/2016 I 06/26/2017 A ',Equipment Floate 01C181015420 06/26/2016 06/26/2017 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) L l'CIN 1 Irll,H i c flO LJLf\ CITY-92 City of Okeechobee 55 SE 3rd Ave Okeechobee, FL 34974 _••. ^- - -""-'- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CH 0 EE WESTLING RESENTS 1 ST Annual BBQ Fundraiser Prepared by: Kyle Reno $10 a Ticket Brahman Theater Friday -June 16, 2017 11 am 2pm Dinner Includes: Pulled Pork, Baked Beans, Coleslaw, Roll, Cookie Delivery for 3 or more Tickets available at Serenity Coffee Shop 863 - 824 -2287