HomeMy WebLinkAboutName Change Application RECEIVED
PLANNING AND DEVELOPMENT SERVICES
2300 Virginia Ave JUL 0 9 20ZI
COUNTY Fort Pierce,FL 34982
Phone:772-462-2822—Fag:772-462-1581 St,
PePrmierm Countytting
APPLICATION
FORA BUSINESS NAME OR OWNERSHIP CHANGE ONLY
(Not Home Office Use)
Permit Number. Date of Application: 10a Z
Name of Business: Rloz
New Business Name(if changing): chotl6k
i
Name of Current Business Owner:
Name of New Business Owner meckomWood
Address of Business: State: _ Zip: 2
Name of Shopping Center, if applicable:
Property Tax ID#for Business Location:
Description of Business: (include a detailed description) bmiz ctce-
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Name&Type of Previous Bus' ess at this Location: . M0 WAIW IAILIUQ,(�S - C
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Attach a copy of the current,active copy of the Business Tax Receipt for the business/property.
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Name of Applicant: h
Address: 1 State: _ Zip:
Phone Number: - Q Email ddress: L_ a Coo'
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:
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Required Yes No Comments
POD Initials Business Tax Receipt
Revised:March 2019