HomeMy WebLinkAboutPlanning and DevelopmentPLANNING AND DEVELOPMENT SERVICES
2300 Virginia Ave
Fort Pierce, FL 34982
Phone: 772-462-2822 - Fax: 772-462-1.581
APPLICATION
FOR A BUS/NESS NAME OR 0WNERSH/P CHANGE ONL Y
(Not Home Office Use)
Permit Number: Date of Application: 6 Za
BUSINESS INFORMATION
Name of Business:
� l
New Business Name (if changing):
Name of Current Business Owner: 'L
Name of New Business Owner
Address of Business: o-�q-3 S �-(� r State: �'� Zip: 34
Name of Shopping Center, if applicable: G0Rr)1&i,' % k2
Property Tax ID # for Business Location: 341Y S.''I • C a.;to • 4
Description of Business:, (include a detailed description)
Name & Type of Previous Business at this Location:
Attach a copy of the current, active copy of the Business Tax Receipt for the business/ property.
APPLICANT MAILING ADDRESS
Name of Applicant:
Address: jA 9 4jS. J S (-h-�,x�yk-y State: - Zip: �4 �6
Phone Number: i"la-.(�p 6�o`�jro Email Address: 42-0-"owS * A4
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, and property maintenance regulations.
Applicant's Signature: Date:
OFFICE USE ONLY:
Yes No Comments
POD Initials Business Tax Receipt
Revised: March 2019