Miami Dade County Department of Planning & Zoning Zoning Permits Section- 11805 SW 26 Street, Suite 106 Miami, FL 33175 Phone 786-315-2666 Fax Completed Application to 786-315-2928 APPLICATION FOR CERTIFICATE OF USE FOR LIQUOR / BEER AND/OR WINE New Business Information Business Address: __________________________________________ Unit/Suite: ________________ (List all Addresses above) City:______________________________________ State: __________ Zip Code: ________________ Mailing Address: ____________________________________________ Unit/Suite: ________________ (List all Addresses above) City:______________________________________ State: __________ Zip Code: Name of Business/DBA (Doing Business As): _________________________________________________ Name Corporation: ____________________________________________________________________ Corporate Officer / Business Owner Name:______________________________________________________________________________ (Last Name) (First Name) Telephone Information Business Phone Number (____)___________________ Fax Number(____) ______________________ Location Information □ □ Size of Space (sqft) __________________________ Alcohol Type(s): Liquor Building Type: Grocery Store Other □ □ □ Bar □ Package Store Cabaret □ Restaurant □ □ Wine Lounge □ □ Beer Night Club Explain:_______________________________________________________________________ Will you be sharing space with another business? _________ Comments: ________________________ (Yes/No) Will used merchandise be sold on the property? __________ Comments:_________________________ (Yes/No) Describe the type of business: __________________________________________________________ ___________________________________________________________________________________ Signature of applicant verifies the above information is true and correct. I understand the conditions under which my Certificate of Use (CU) is being approved and accept that no charges or refunds can be made once issued. I am authorized to sign for the business and understand that any misrepresentation of information on this application may result in the revocation of the CU and/or possible enforcement action being initiated against the business and/or it’s authorized representatives. I further understand that a separate Certificate of Occupancy (CO) is also required and is obtainable from the Building Department. Print Name: ________________________________________ Signature X _____________________________________ Department Use Only: Do not write below this line _____________________________________________________________________________________________________________________________________________________________________ Zoning: ____________________________________________ Processor: ______________________________________ Conditions under which approved: ________________________________________________________________________ Resolutions: _________________________________________________________________________________________ Process Number: U ______________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com