HomeMy WebLinkAboutZoning/Name Change PLANNING AND DEVELOPMENT SERVICES
2300 Virginia Ave
COUNTY
Fort Pierce,FL 34982 RECEIVED
Phone: 772-462-2822-Fax: 772-462-1581
APPLICATION St.Lucie County
FOR A BUSINESS NAME OR OWNERSHIP CHANGE ONL Y Permitting
//�� (Not Home Office Use)
Permit Number: � V�4 Date of Application:
INEK 7ii-USIMSS ANEQ4MATIQN,
Name of Business:
New Business Name (if changing): C
Name of Current Business Owner: /,L' V id (T SQA)
Name of New Business Owner �A Sd � c— A)G,.
Address of Business ` �7( S US N i G r=(u,),4 L/2 State: e- .,16<-zip: g2
Name of Shopping Center, if applicable: 5 ._ SO O 2-- 20 n••—
Property Tax ID # for Business Location:
Description of Business: (include a detailed description)
Name &Type of Previous Business at this Location: S f(O
Attach a copy of the current, active copy of the Business Tax Receipt for the business/property.
APPLICANT MAILING ADDRESS
Name of Applicant:
Address: 17 S A NC� �, RI)5 j State: Zip:
A � -
Phone Number: 5 G ( - 5 9 -276 Email Address: So,,, Ct�1��C.�: � 7
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 pr maintenance regulations.
Applicant's Signature: Date:
Required Yes No Comments
- - -- —
POD Initials Business Tax Receipt
Revised: March 2019