HomeMy WebLinkAboutAPPLICATION FOR A BUSINESS1 03io
PLANNING AND DEVELOPMENT SERVICES
2300 Virginia Ave
° Fort Pierce, FL 34982
e Phone: 772-462-2822 - Fax: 772-462-1581
APPLICATION
FOR A BUSINESS NAME OR OWNERSHIP CHANGE ONL Y
(Not Home Office Use)
Permit Number: Date of Application:
BUSINESS INFORMATION
Name of Business: GE y f ,S Cp P
New Business Name (if changing): Si 11-r- - -Ir
Name of Current Business Owner:
Name of New Business Owner
Address of Business: 5855 �12��G� 4yE, State: �L� Zip: -j - it)
Name of Shopping Center, if applicable: -
Property Tax ID # for Business Location:
Description of Business: (include a detailed description)
Q► I) UTG 2 OF 120-► G&To U Gt ATt O —4Qia
Name & Type of Previous Business at this Location: 0ja.04,
U CIF-!Tl C(�4► _
Attach a copy of the current, active copy of the Business Tax Receipt for the business/property.
APPLICANT MAILING ADDRESS
Name of Applicant: t,-AE
Address: (off STr �iSp�J, N� 1 State:' �-M Zip: 3 -1
Phone Number: 248 �37z 42--12 Email Address: I A
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 businesslproperty; 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 , nd property mai tenance regulations.
Applicant's Sig/ nature: �Date:
OFFICE USE ONLY:
Required Yes No Comments
POD Initials Business Tax Receipt
Revised: March 2019
25
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Officers of SiteOne landscape Supply LLC
Doug Black — CEO
300 Colonial Center Pkwy
Roswell, GA 30076
470-277-7020
John Guthrie — CFO
300 Colonial Center Pkwy
Roswell, GA 30076
470-277-7013
Briley Brisendine — Executive VP & General Counsel
300 Colonial Center Pkwy
Roswell, GA 30076
470-277-7167