HomeMy WebLinkAboutAPPLICATION FOR A BUSINESS NAMEPLANNING AND DEVELOPMENT SERVICES I RECEIVED
2300 Virginia Ave
Fort Pierce, FL 34982 FEB 16 2022
Phone: 772-462-2822 - Fax: 772-462-1581
APPLICATION
(Not Home Office Use)
Permit Number.
Date
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BUS' !� SS INFO + ilia
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Name Dee' SQk 0V\ 1,-\ �
New Business Name (if changing): ,Iq C �CA nc�
Name of Current- ner: D 2V-1 t �e �rr►SUn
Name of New Business Owner
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Address of Business: (G 2_ J ' ', hWq , �or' St LuCIIState: -` Zip:
Name of Shopping Center, if applicable:
Property Tax ID # for Business Location:" 15 - S (3- G5'- n
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Description of Business: (include a detailed description) ' q 10
Name & Type of Previous Business at this Location: S y n
Attach a copy of the current, active copy of the Business Tax Receipt for the bl
siness/property.
APPLICANT MAILING ADDRESS -=�
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Name of Applicant: 11A 0
Address: 27 50 5t.j goc _ State: _
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Zip: 314012�i
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Phone Number: _ -_ Email Address: ,�(1Ve�me RX3�
This application is only to update an owner name or business name. To qualify forlthis 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:
77
Required
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POD Initials Business Tax Receipt
Revised: March 2019