HomeMy WebLinkAboutLocal Business Tax Receipt PLANNING AND DEVELOPMENT SERVICES On
2300 Virginia Ave J
• , _ Fort Pierce,FL 34982
_ _....__.... Phone: 772-462-2822-Fax: 772-462-1581
APPLICATION
FORA BUSINESS NAMEOR OWNERSHIP CHANGE ONE Y
(Not Home Office Use)
Permit Number: Date of Application:
BUSINESS INFORMATION',
Name of Business: FdbnCk&_Y_
New Business Name (Ifchangv: Q an e LC
Name of Current Business Owner: r �n m5r
Name of New Business Owner
Address of Business: k SL, State: 'FL Zip: 34R5Z
Name of Shopping Center, if applicable: n ra
Property Tax ID #for Business Location: 2d Is — 501 —0010 _000 —�-
Description pf Business: (include a detailed description) elf)If VWae
w n
Name & Type of Previous Business at this Location: -F —
a �
Attach a copy of the current,active copy of the Business Tax Receipt for the business/property.
APPLICANT MAILING ADDRESS
Name of Applicant: 0
Address: Ulf
State: �� Zip: 2
Phone Number: 0�-� 3 Email Address: GInVi:� r
This application is only to update an owner name or business name. To qualify for this application, there must be an active
business tax receipt for the business/property;no change of use(change or modification of the character,type or intensity of an
existing use or the inclusion of additional uses) may be proposed; and no erection,alteration, construction, reconstruction or
any type of development involving a building, structure, paved parking area, driveway connection, or impact upon a protected
natural habitat. I further understand that a site inspection may be required to ensure compliance with applicable land
development,building safety,a ig pr perry maintenance regulations.
Applicant's Sign Date,
OFFICE USE ONLY:
Required Yes No Comments
POD Initials Business Tax Receipt
Revised: March 2019