HomeMy WebLinkAbout08-7442
CITY OF ZEPHYRHILLS
5335-8th Street
(813) 780-0020
ELECTRICAL PERMIT
'YKH
7442
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Contractor:
Square Feet:
Est. Value:
Improv. Cost: 475.00
Date Issued: 1/30/2008
Total Fees: 35.00
Amount Paid: 35.00
Date Paid: 1/30/2008 Phone:
Work Desc: INSTALL 2 OUTLETS FOR TV IN CONDUIT ALONG WALL-NO RELEASE REQD
7442
ELECTRICAL MISC
ELECTRIC SERVICE/NEW
COMMERCIAL
WESLEY CHAPEL ELECTRIC LLC
Address: 7403 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block:
Book: Page:
'Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 34-25-21-0000-00300-0020
Section:
Name: MERCHANTS STATION LLC
Address: 3300 ENTERPRISE PKWY
BEACHWOOD, OH 44122
N~~. t~ t,0hsvY")
o..pp~ . '
ROUGH ELECTRIC
FINAL
r~ (\C~dJ
".2.( do<?:
~
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are
necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction
c) repairs or corrections not made when inspection called d) work not ready for inspection when called e) permit not posted
on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same.
"Warning to owner: Your failure to record a notice of commencement may result in your payin
twice for improvements to your property. If you intend to obtain financing, consult with
your lender or an attorney before recording your notice of commencement."
Complete Pl ,Specifications and Fee Must Accompany Application. All work shall be
performed accordanc ith ty Codes and Ordinances.
~M~
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
WORK PROPOSED
I
E3 NEW CONSTR ~ ADD/ALT D
INSTALL REPAIR
PROPOSED USE D SFR COMM D OTHER I I
TYPE OF CONSTRUCTION ~ BLOCK D FRAME D STEEL D OTHER I I
DESCRIPTION OF WORK I /p~'114"'^- .:zen- O,J7UZ;'T~ ~ '11.1 (JJo~ tAla'^- ,0'\1 c~"'c.'r.1
~~:~~,'~~, ~~~"" ,I""" Ii:':'~' ~'" ,~~ ,~~~~?,~), &~,~::::.!,',. ~~:?~~, ,I", ~:,""""" ,I""""""""""" ,
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Owner Phone Number
Owner Phone Number I
Date ~eceived
Owner's Name
Owner's Address '7 yO'>
Fee Simple Titleholder Namel '
SUBDIVISION
o
lJ5V~/~
~'-'-
LOT #
JOB ADDRESS
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE D
DEMOLISH
D
1$ I
1$ Y;/3-/f: I
D PLUMBING 1$ I
D MECHANICAL 1$ 1
D GAS 0 ROOFING D SPECIALTY 0 OTHER
FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII!IIIIIIIII11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
ELECTRICAL
AMP SERVICE ~ ~
PROGRESS ENERGY
D
W.R.E.C.
BUILDING
VALUATION OF TOTAL CONSTRUCTION
ta
VALUATION OF MECHANICAL INSTALLATION
Address
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
I
I
'- L- 9-
BUILDER
SIGNATURE
License #
ELECTRICIAN
SIGNATURE
I~~
~E~;Z- ~~~
License # I L:"<< ~ i
Address
PLUMBER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
COMPANY
REGISTERED
MECHANICAL
SIGNATURE
Y / N
FEE CURRENT
Y/N
Address
License #
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
License #
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I1
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
Minimum ten (10) working days after submittal date. Required on site, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required on site, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
DI~~~ii~~~': ' , , . , . , , , , , , , , , . , . , , , , . , . , . . . . . , , , . . . . , . . , . . . . . . . , . . . . . . . . , , . , . . , . . , . . . . , , , . . , , , , . , . . . , . . . , . , , , , , , , , . . . , . , , , , . . . , . . , , , , , , , . , , , , , , , , , . , ,
Fill out application completely.
Owner & Contractor sign back of application. notarized
If over $2500, a Notice of Commencement is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades AlC Fences (Plot/Survey/Footage)
Address
111111111111111
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County. '
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction' Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properti~s, the.ow.ner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required. . . . . .
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permlttln~ condItions s~t forth In
this affidavit prior to commencing construction. I understand ~hat a s.eparate perm~t. may ?e reqUlr~d for elect~lca.1 work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically 1n~luded. In the application. A
permit issued shall be construed to be a license to proceed with the work a~d not as authorl~y ~o. vlol~t~, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the B~II.dlng OffiCial from the~eaft~r
reqUiring a correction of errors in plans. construction or violat~o~s o~ any codes. Eve'!' ~ermlt Issued. shall become. invalid
unless the work authorized by such permit is commenced Within SIX months o.f permit Issu~nce, or If work authorized. by
the permit is suspended or abandoned for a period of six (6) months after the time th~ work IS commenced: An extension
may be requested, in writing, from the Building Official for a period not t~ exceed mn~ty ~90) da~s and Will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the\Job IS considered abandoned.
WARNING TO OWNER" YOUR FAILURE TO RECORD A NOTICE OF COM MEN EMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEN OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NO OF COM CE NT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or haslhave produced
as identification.
"V' n
Notary Public
~O~ ~~
Notary Public
Commission No.
Commission ~~;;, Karel. L. Miller
~:t '~ Commission
Name of Not r6r 29, 2010
,.n\: Bonded Troy Fain' Insure,.., lnl 1OO~7018
Name of Notary typed. printed or stamped
r
larouosal Page #
Wesley Chapel Electric, LLC
25678 Inkwood Place
Wesley Chapel, FL 33544
813-973-1141 or 713-0964
wcelectric@Verizon.net
/ of
Address
Date of Plans
Phone #
-
We he,"b, su"'", spec,;cations and esl;mates to'.. . ...._.~/ ... '.'<--.'Ilrr.22"r~ .. v><Q
==:r~=~~~ti=12~~~r~&-~.~--=~.~Z:~..;'~;:(::==
$
Respectfully
submitted
Note - this propos
~tteptante of ~roposal
The above prices, specifications and conditions are satisfactory and are Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance
Any alteration or deviation from above specifications involving extra costs will be
executed only upon wrillen order. and wUl become an extra charge over and
above the estimate. All agreements contingent upon strikes. accidents. or deiays
beyond our control.
Signature
DolIID'S"
o days.
Annual
Zephyrhills Fire Rescue
6907 Dairy Rd
Zephyrhills. 33542
Phone:813-78~041
Fax:813-78~044
_ Inspection Date: 1/1712008 10:oo:00AM
lip inspectorName: Hector Noyas
Inspection Number: 1-113-08-0215
InspectionCause: Periodic
Insneetsd Partv
BROOKSIDE DENTAL CARE
(000106)
7403 GALL BLVD
ZEPHYRHILLS, FL 33542
Phone: 813-779-7722
OccupancyType: Healthcare
PropertyUseType: Dentist Office
ViolationCounts: 1
Hrs: 0.30
,,-;,'-....
Notice: Correct Immediately
Ref. Number: NFPA 1 (2003) 11.1 Electrical Fire Safety 11.1.5 Electrical Fire Safety.
Extension cords shall not be used as a substitute for permanent wiring.
Comment: ORANGE EXTENSION CORD SUPPLYING POWER TO WALL MOUNTED TELEVISIONS MUST BE REMOVED. WALL
OUTLETS SHALL BE INSTALLED BELOW DROP-CEILING TO SUPPL Y ELECTRICAL POWER. ELECTRICAL PERMIT
REQUIRED.
Comments:
INSPECTION FAILED
Re-Inspection to be performed on or before: February 18, 2008 12:00 am
Sign Here
Page 1 c
10-30-2007
ALEX SINK STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPAR-rMENT OF. FlNANClALSERV1CES
DIVISION OF WORKERS' COMPENSATION
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law.
EFFECTIVE DATE:
10/30/2007
E~Ti6N';~:WI2912D89
PERSON: HOOKER
FEIN: 204003134
BUSINESS NAME AND ADDRESS:
WESLEY CHAPEL ELECTRIC LLC
2.5678 IN<WOOD PLACE
WESLEY CHAPEL FL 33544
FRANK
R
SCOPES OF BUSINESS OR TRADE:.
1- ELECTRICAL CONTRACTOR
IMPORTANT: f'ursualll 10 Dlpter 4411 . 0504!. f.S.. In ollicer 01 . corp anti on who elects exemptioa from Ibis chapter by'iillRg a certificale of elecllon under Ihis
section may not recover beaelits or cOIIIpensllion uoder this chlpler. Pursuanl to Chapler 440.05HZ). f.S., Cenilicates 01 eleclion to .be nempl... apply only within the
scope 01 the bosi.ess or trade listed llII JlJe oolice of eleclion to be exempt. Pursulnl 10 Chapter ..40.0liOS), f.S., NOlices of election 10 be exempl and certificates of
election to be exempt shan b. subject 10 rl!Yllcation if, at ony time after lb. filing 01 tile Dlllic. or the issuonce of the certi/klle, Ibe person Darned on the notice or
cerlillcote no longer meels the rl!lluir_ 01 IIIls seclion for issuance of a certificate. The departmeol shall revoke a certificale 01 any lime lor failure of Ihe person
nomed on tile "ertifielte to meet lire ....r_s of this secllon.
QUESTIONS? (850) 413-1609
'"
~'al Liability Declarations Page
Agent Name:
Agent Phone #:
Named Insured:
Mailing Address:
Policy Nwnber:
Previous Policy ID:
Effectiv(, Dates:
Activity:
Business T)'Pe:
Coverages and
PremiuDlS:
Location Address:
Forms and
Endorsements:
Important Notice to
Policyholders:
Neigh~rhood Ins Services Inc.
14949 N Florida Ave
.,
Tampa, FL 33613
,;,m" Dec'",:.MI
American
StRU<jit
J~an(f
(813) 935-1561
. -AgeocyCode: 412280
Wesley Chapel Electric LLC
25678 INKWOOD PL
WESLEY CHAPEL, FL 33544
Insuring Company:
American Strategic Insurance Corp
805 Executive Center Drive W Suite 300
Saint Petersburg, FL 33702
Phone: (727) 374-2502
FLR34253
FLR34253
From: 01105/2008' To: 6'l1~
At 12:01 AM Standard'"Fime'aMhe'3geltt~,
Renewal - General Liability
J1;t'reeti?e.~tIIilbcT""n.2Cfia..:
ltil.2l.108
Corporation
Coverage for liability per referenced forms and endorsements is provided only where a limit of liability is shown or a premimn
is stated.
25678 lnkwood PL
Wesley Chapel, FL 33544
Asr C 0002 10 04
ASI GL 0006 10 02
AS! RISC 0001 1002
CG 21 47 07 98
CG 21 67 12 04
ASI RISC 0002 12 04
ASI GL 0003 07 03
ASI GL 0007 10 02
CGOOOI1204
CG 2149 09 99
IL09 85 01 03
CG22 941001
ASI GL 0004 10 02
CG 21 86 12 04
CG 02 20 11 06
ILOO21 0702
CG 24 260704
CG 21 70 11 02
AS! GL 0005 10 02
AS! GL 0009 10 02
CG21 460798
CG 03000196
ASI C 000110 02
THIS INSURANCE APPLIES ONLY TO WORK ARISING OUT OF OPERATIONS WIDCH ARE CUSTOMARY
TO THE CLASSIFICATIONSHOWNIN THE CLASSIFICATION SCHEDULE WHETHER OR NOT
INCIDENTAL.
IF YOU SUBCONTRACT WORK TO OTHERS, YOU MUST OBTAIN A CERTIFICATE OF INSURANCE
FROM THE SUBCONTRACTOR DEMONSTRATING GENERAL LIABILITY COVERAGE INCLUDING
PRODUCTS AND COMPLETED OPERATIONS COVERAGE WITH LIMITS NOT LESS THAN $100,000.
OPERA nONS PERFORMED BY SUBCONTRACTORS WITHOUT ADEQUATE INSURANCE SHALL BE
CLASSIFIED AND RATED IN THE SAME MANNER AS THOUGH WORK WAS PERFORMED BY YOUR
Etl.1PLOYEES.
THESE DECLARATIONS, TOGETHER WITH POLICY CONDITIONS AND COVERAGE FORM(S) AND
A.l'<J\'ENDORSEMENT(S), COMPLETE.THE ABOVE NUMBEREDPOLIC\'.
I(~~ U:l1!
Countersigned by Authorized Representative ST. Pet~ Florida
Date: 11105/2007 ASI GL DEe 12 03
:- tPf.~-
* "*
. ..."*
=~= =_='t:>~'l"Q.L.:r:C
POBOX 4668
WINTER PARK/
k!mlETY COMPANY
:~" --.-
- CONTINUATION CERTIFICA i~ _7
FL 32793-4668
BOND NUMBER
BOND DeSCRIPTION
BONO AMOUNT
EFF~'
OFL- 560719 ELECTRICAL CONTRACTR 5/ 000. 'T~
!~~Uil\W$IR.W~~iill*t~~~[Ml~!ki1~~;~llM*t~~1l:~i~ii@llig~:~;@M;;~~~~M~MWlMnmf1i~;~jtM@~~lWI~Wft~IitMIii~!tttt@l~1&dtlifiif1f.tilf~r:'~::"~~*:<.~~i;t:,*,,~:~_lt:*,,:~@~~m~~f.i
"......., - . HOOKER/ FRANK R. . -. ....
DBA WESLEY CHAPEL ELECTRIC LLC
25678 INKWOOD PLACE
WESLEY CHAPEL/ FL 33544
f~*~111~t1ii;@ji~lli1~i~ij~~~~!fl~fJj@ful~~~~11mljl~11t~ii~f.~lmillmi~Illi~~I~ili~~t~\1fi~;WH\~[ji~;i@1~illl~iK~m~lt..f~llliit'l:t~til'lfgt~\~l1~:jili?i1.?1
PASCO CTY ATTN: SUE
LICENSING BOARD
7432 LITTLE ROAD
NEW PORT RICHEY/ FL
34654
.. . . ~:;fll~i1J.l~ff.~jl~~~t.!1~~'lI~.iD.~j!~~_S~~I~jl%~~~
THIS BOND CONTINUES IN FORCE TO THE ABOVE EXPIRATION DATE CONDITIONED A NO PROVIDED THAT THE LO ,~i <.J !e: ii r; r-;:: r :M,t:
IT AND ANY AND ALL ENDORSEMENTS SHALL NEVER EXCEED THE PENAL TV SET FORTH IN THE BOND AND WHETH HCLO.ID>SS:O*l \ 'ii? I ~
RECOVERIES ARE WITHIN THE FIRST AND/OR SUBSEQUENT OR WITHIN ANY EXTENSION OR RENEWAL PERIOD, P~~NT...P!ST OR FUTU~'.~ /I
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. lUll S t P ] 0 2007 II
t I..J - I
~
lay
-=
I
92-2474
NEIGHBORHOOD INSURANCE SVCS.
14949 NORTH FLORIDA AVENUE
TAMPA, FL 33613
OLD RRPUBLIC SURETY COMPANY
SURETY
SIGNED AND DATED THIS
FIFTH
DAY OF SEPTEMBER, 2007
By_
'. .'. -'.:til.f;)tl~if!i!~f~f~f:tl$1~1;~~~~j[ifgi~t~~il~~[!~?ttmt~~~~ilf~~~i~i~~i~~~~_.
ACCOUNT NO: 64269
SIC CODE: 1731.02
TYPE OF BUSINESS:
ELECTRICAL CONTRACTOR
WESLEY CHAPEL ELECTRIC LLC
25678 INKWOOD PI.
ZEPHYRHILLS FL 33544-5119
luntil UII hlllli lislltllltlUllllt nllJ.ln 1111111 ,MI. It i .
. --~"_,-,..-~-_.,.., ....~,._~~-.......\...,"'-"-<-~,, ",,~,"~- ,,,,,~,,,-,,,w~,",,.,,,;,,~.<_...,__~=--\.,, '~_."~ ".~-,~ ,.~,~_..__~ y"", ---'_.w~....". _~ ~...,_."..~ ".".,
-;:::-...~,..-'~~!:-7:",,:~~::'-~~_"'.j.~'~b:<::.:-o-,.."..,.~r':7-:,r::;.,',..:.~f<"'..",,: .,.""_-,_",.-,i~',~'-~"""",,,,--- ,,"" ,.".,-__~,'.........." ".' ",e<>_.". ._, "..~. _. ~ .
OFFICE DISPLAY CARD
DEVELOPMENT REVIEW SERVICES DEPT.
CONTRACTOR LICENSING
CERTIFICATE OF COMPETENCY
015526
I.D.#
Be it knclwn that: F
C.C: EH ....05869
E:L.ECTR r
CI fJ i4E8LEY
~~~:61' e I
2:t:PHYRHI
LLC
~ rL. .33544.
UNDEEt.SEC.18 PASCC>:COUNTY CODE HAS MET THE
PROVISII < oft'A::QE11'l'fFICATE OF COMPETENCY
.,,.,.', ....""~,--"'-,-,""
LOCATION ADDRESS:
25678 INKWnOD Pl
ZEPHYRHIllS
DATE RECEIPT AMOUNT
08/14/07 530022 31,25
_~ , _~l~
l"""to..,J$-.J_,n~~,r. !'.1.j,!,~I!\l.,~< ,,) l. _.I.,._~ l_lH.~~JI,_H Mi~__.ij!i.mr:~'- :"--'1"t.~ '.....