HomeMy WebLinkAboutApplication Business Name Or Ownership Change OnlyPLANNING AND DEVELOPMENT SERVICES
2300 Virginia Ave
Fort Pierce, FL 34982
Phone: 772-462-2822 - Fax: 772-462-1581
APPLICATION
FORA BUS/NM NAME OR OWNERSH/P CHANGE ONLY
(Not Home Office Use)
Permit Number: Date of Application:
Name of Business:
New Business Name (if changing):
Name of Current Business Owner: '/"T" L9
Name of New Business Owner 0 Y
Address of Business: �/,/ (,1 ��pm-� (��,, �s �`� State: 6 Zip: J
Name of Shopping Center, if applicable: P/e � , e_ 4 / !-2-
Property Tax ID # for Business Location: f, Y5L 37 7 02 d 42U -�
Description of Business: (include a detailed description)
Y
Name &Type of Previous Business at this Location: Y�
Attach a copy of the current, active copy of the Business Tax Receipt for the business/property.
WOs,, ,� ,
Name of Applicant: ,v ee 2 j C C'l
Address: C t—. V ht7 sod State: - Zip:
Phone Number: -23,)- 3 [aL Email Address: lZ/ CCI� 3pv /�tlyc�� C
ZA
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:2
'F{ J4^� +arc
.'-•T .}<4 �u ,�w�..:�.��'3O
N rta 2#.0�„�;r,�9�,
r�S�3 .AtPr,;. � ,5�•.kl. �`.f5'�. 4�, ,-�..i':< � ... 1-.'.'�i.s. ,.,� ..wh.
Required
Yes No Comments
POD Initials
Business Tax Receipt
Revised: March 2019
A