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Home My WebLink About11-11728 • CITY OF ZEPHYRHILLS 5335-8th Street , . (si3)�so-ooao 11728 ELECTRICAL PERMIT Permit Number: 11728 Address: 7326 GALL BLVD Permit Type: ELECTRICAL MISC ZEPHYRHILLS, FL. Class of Work: ELECTRICAL MISC Township: Range: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Contractor: BLACK BOX NETWORK SERVICE Book: Page: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-08800-0000 Improv. Cost: 10,000.00 Date Issued: 4/04/2011 Name: TOWNVIEW RETAIL LLC Total Fees: 127.50 Address: 725 CONSHOHOCKEN STATE RD Amount Paid: 127.50 BALA CYNWYD PA 190042102 Date Paid: 4/04/2011 Phone: (610)667-5800 Work Desc: LOW VOLTAGE 30 VOICE LINES, 34 DATA , 30 SPEAKERS & 7 VOLUME CONTROL ELECTRICAL FEE 127.50 1 \ //� / ,� �V ROUGH ELECTRIC CONSTRUCTION POLE � PRE-METER FINAL REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection trips are necessary due to any one 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 paying 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 Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. . � '(�O' CONTRACTOR PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ,v?��y�,.,�..St�i r � � � -, ci�' ��.Pt1! !" ;� � ,�; ,� �..� �� City of Zephyrhills BUILDING PLAN REVIEW COMMENTS �__._ ___\ entracto omeowner: f/ v� �JB. ,� --��c'.�s � Date Received: � - � l - f� Site: ��'� v�� G��- . '� y �� , �-�� Permit Type: �_(i� s 3 ,� � U c-� � t�'.�� Approved w/no comment� Approved w/the below comments: ❑ Denied w/the below comments: ❑ This comment she t shall be kept with the permit and/or plans. �� Kalvin Swi - s E 'ner Date Contractor andlor Homeowner (Required when comments aze present) "`.� 5 �� r ��""�'� � il i�9� � s�s-�eaoozo City of Zephyrhills Permit Application Fax-813-730-OC21 . , BuildingDepartment / ��.— - � �/(�� < �if ' �(� / a ' .3 'S %�, L.. I�°,rVF �= Date Received � --^ �� Phone Contact for Pertnittin �� - �� u _� T i —� Owners Name /,/ �M{ i � J�� Owner Phone Number Owners Address � LI'�/�'�y R U � Owner Phone Number � _] Fee Simple Tkleholder Name Owner Phone Number _] Fae Simple Titleholder Address _] JOB ADDRESS 3 L °7A7L 1.iL✓a/ ZEPI�`L �1(�LI / r' (� �T LOT # C] SUBDIVISION � PARCEL IDIf ] (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED B NEW CoNSTR 8 ADD/ALT Q SIGN Q Q DEMOLISH INSTALL REPAIR PROPOSED USE Q SFR Q COMM � OTHER � TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEL Q � DESCRIPTONOFWORK �6 ��w L�NE � 3� 1 kNE�� O s�� I(�`GYy1G �,�1cvGS BUILDING SIZE � SQ FOOTAGE � HEIGHT � QBUILDING S VALUATION OF TOTAL CONSTRUCTION QELECTRICAL $ ��• oO AMP SERVICE Q PROGRESS ENERGY � W R.E.C. c QPLUMBING $ � � ��`� l �MECHANICAL $ VALUATION OF M HANICAL INSTALLATION � QGAS Q ROOFING Q SPECIALTY � OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO BUILDER COMPANY ] SIGNATURE REGISTERED Y I N FEE CURREN Y/ N Address License # ] ELECTRICIAN COMPANY ] SIGNATURE REGISTERED Y/ N FEE CURREN Y/ N Address License # ] PLUMBER � � COMPANY ] SIGNATURE REGISTERED Y I N FEE CURREN Y/ N Address License # ] MECHANICAL COMPANY ] SIGNATURE R RED Y/ N FEE CURREN Y/ N Address 1 �l License # ] OTHER � COMPANY �x �t1STt��q.��'eV�1'��o'lsdv>rr�rs . SIGNATURE �� REGISTERED Y/ N FEE CURREN Y/ N Address �zN n� �G 7/� License# �.s0��.�69 ] Illllllllllllllllllllllllllllllitllllllllllllllllllllllllllllllllll � RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Fortns; R-O-W Pertnit for new consUuc[ion, Minimum ten (10) working days a4er submittal date. Required onsite, ConsVuction Plans, Stortnwater Plans w/ Silt Fence installe�d, Sanitary Facilities & 1 dumpster, Site Work Pertnit for subdivisions/large projects COMMERCIAL Atfach (3) complete sets of Building Plans plus a Life Safery Page; (1) set of Energy Fortns. R-O-W Pertnit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Constructlon Plans, Stormwater Plans w/ Sift Fence installed, Sanitary Fadlities & 1 dumpster Site Wark Permit for all new projects. All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Plans. """PROPERTY SURVEY required for all NEW consWction. Directions: • Fill out application completely. Owner & Contractor sign back of application, notarized If over =2500, a Notice of Commencement is required. (A/C upgrades over E7500) '"' Agent (for lhe coMractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Service Upgrades A/C Fences (Plot/Survey/Footage) 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 Counry 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 i 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 Impad i fees are due, they must be paid pnor to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Flortda Statutes, as amended): If valuation of work is $2,500.00 or more, I certity that I, the applicant, have been provided with a copy of the "Florida Construction Lien �aw—Homeowne�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 instailation has commenced prior to issuance of a permit and that all work will be pertormed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land devefopment 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 Watenvays. - Department of Health 8 Rehabititative 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 certiiy 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 properties, the owner may be cited for violating � the conditions of the building permit issued under the attached pertnit 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 permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically inGuded in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days 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 COMMENCEMENT MAY RESULT IN YOUR PAYING 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. e^ FLORIDAJURAT(F.S.117.03) ��. � OWNER OR AGENT CONTRACTOR a�,�� c�x ,v�r�� •-r s J ° Subscribed and swom to (or affirtned) before me this Sub ' and swom to� (o�r afirmer bef�re� ine this bY 30 / by TDD � ( AO �: nn �,� Who is/are personalty known to me or has/have produced o is/ personally known to me or has�have produced as identficadon. as identlfication. Notary Public / '7`� Natary Public Commission No. Commission No. � (p Name of Notary typed, printed or sfamped Na Nota�ri2t�d� r�� r'ey�•• LYNN M. MARQUAHDT :� �:: ;,, .r MY COMMISSION # DD 766910 � �as EXPIRES: April 13 2012 �%'�'„�of N,°,Q`� Bonded Thru Notary Public Underwriters ;:> s�AcK sox� h��.� ,� �� ` �� GOVERNMENT SOLUTIONS POWER OF ATTORNEY � Date: 3/30/2011 I hereby name and appoint Lonnie Musser Of Black Box Network Services, Inc — Government Solutions to be my lawful Attorney in fact to act for me and apply to the Citv of Zephryhills Building Department for a Low Volta�e Communications permit for work to be preformed at a location as: Section: Township: Range: Lot: Block: Subdivision: Town View Shopping Ctr. 7326 Gail Blvd. Zephyrhills, FL 33539 (Address of job) TJMaa�x Store # 1194 (Owner of Property) and to sign my name and do all things necessary to this appointment. Todd J. Chouinard ES0000369 Type or Print Name of Certified Contractor and Contractor's License Number / • Sign e of Certified Contractor The foregoing instrument was acknowledged before me this � 30 day of 20 �/ �--�- � By I a DU� cLi who is ersonall known to me/who produced as identification and who id not take oath. a�%'Py�- LYNN M. MARQUAEIDT State of Florid :: �'�� MY COMMISSION # DD 766910 COUrity Of �-c � ':;•��g' EXPIRES: April 13, 2012 '�'f�, j� f��°,Pr Bonded Thru Notary Public Undenrriters Seal Not Public, � Cou y, Florida �c_ 3247 Tech Dr North, St. Petersburg, FL 33716 Phone: 727.571.4144 Fax: 727.573.5789 State Lic: ES0000369 �°'�m""°"°�• STATE UF FLt7RIDA _ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION p'.' �'�� ELECTRICAL CONTRACTORS LICENSING BOARD ($50) 487-1395 1940 NORTH MbNROE STREET ��K�T°' TALLAHASSEE FL 32399-0783 CHOUINARD, TODD JOSEPH $LACK BOX NETWORK SERVICES INC - GOVERNMENT SOLUTIONS 6471 5T'H AVE N SAINT PETEI2SBURG FL 3371� �._...... m.....,�_.._,._.__.�____. _..___...-----__._ sTare oF �c.v�on AC# S 113 ��, Congretulationsi With this license you become one of the nearly onP million 3 , p.gpARTMENT t}F Bt38TNESS .AND Floridians iicensed by the �epartment of Busmess and Professional Regulation. ; x pRO�'�SS�t?bt�L R$�ULATTON Our professionais and businesses range from architects ta yacht brokers, from -- . boxers to barbeque restaurants, and they keep Fiorida's economy strong � N '` E30Q00369 'R�J2�,�� OOU004�00 Every day we work to improve the way we do business in order to serve you better ? " '` . For information about our services, piease log ontp www.myfloridalicense.com ; CERT. SP�C�1�T'Y,? �•L ��AL CONTR There you can find more infprmation about our divisions and the regulations that ; CHt�IIZNA,RD,'.:- � � �,, , impact you, subscribe to department newsietters and learn more about The � BY,RCI� BO�` �� ,tF�CBS Ii1�C - DepartmenYs initiatives. � �gg,T,�g�g�.• '� �= ��.,; i�• -, LZMITED $' 3€" ��5 SPBC. Our mission at the Department is. License Efficientiy, Regulate Fairly We i constantly strive to serve you better so that you can serve your customers � Ig C � g � = �.� g � „�B= tFsb rovi8iona af Ch.4$9 �s Thank you for doing business in Florida �nd cangratulations on your new license� � �p�xdts�, date: AUG 31, 2012 LI0082�004'i9 DETACH HERE A�� STATE tJF FLORIDA l3EPARTMENT OF BUSIN'ESS AND PROFESSIC)NAV RBGULATIQN EL��CTRICAL CON'TRAC�'ORS i,�CENSTNG 80'A,fi�D S�Q# �1Q08�pp{�479 L�ICENSE NBR 08 20 ZQl{3.00OOQQOOfl ESOOOQ369 The 3PECIALTY ELFCTRICAL CONTR��OR ` "'`� Named below TS CERTIFTED � � �' Under the pro�risians of Chapter :�.89,. FS, 1.� Expiration date; AUG 31, 2012 � A5 A LIMITED ENERGY SYSTEMS 3F��:'�4�i�S� , , C�iOUINAR�. TODD �7'OSEPH ' ,•` `.� BLACK SL�X NETWOR� $ERVICES INC - G�}'�'�. �iT SQLUTIaNS 3247 �L�H.DRSVE NORTH " ST . PETE�'tS$UItG FL 3 3 7].6 CHARLIE CRIST CHARLIE LTEM GOVERNOR SECRETARY DISPLAY AS REQUlRED BY I.AW No Text � � '= ei.,�.i ` d... .,..... (F`ar eh� prr�te�tA�n e�fourprvt'essirsna�lr`cen�e h�fi�rs, t�rr'.� I.�c�er�s� _:>. _��;> �'�i��er� ��r��r`r�+f��tur�� tcr �r��tt r.es�;r�t��{:rrz-�. FJ��Ifr�rr6zed r�e,�xvduct�an es str�ctly prnlrr`Isa��cr' �nr� �ro° ° ,3r�$�:�x%€�z� %, r�aQ< �r,r��sz �xt�}=� : ? ��r� /�c� , ��.i;; a��',i�3:�i'ti t'�t : 3 . .... . . . .. ... . � ,j, . .. i . .7 + , . . , . , ... �- "�r- i�t`s' s ' , _ f �" : ¢"' _. . . . r � s ° t-i . -. "i: `x . r . " , " . ._ � `�3 •' ' � - " F . . :yi�is�rE��:�=c,ct;�c: ._ ._ _ ,�. , . .. ... � �: ., . � � ` r;='.,vv 3�; ;E.k ��.- ��=�3I1x.. f 3"!=;t�l.,i(�: •t'•�t :;();.:!>(S�:N;1�.;3 ;C?i; '{;(�� .szi.: . ':r?!"st- ��.s „ ,. , i t� .. �i=; 9.%#ifk . i� i ,,. ��' , '� I�yiS�{ :3i � i)(J's� i ,�< it� _'i �,C , � , . . �, . . . � . .. " c . � l:( €+':. ? v��:['t'i !:�i` -'7 ;'• Sf,�^ : 1.3i :. ; .i l; iit "�'` L� i . � . ., . ,:lji[i3 t .;�i3t'. ;J�`��'' t .. � ,_ < , :.A1 .� , , ' _ � . - .r ., ; .;iit, . , [ .;t. , (e . , e < < " �. t?", , �., . � , . ; r r ,.,< q t , � , i - . - .. , .� , Idcs�_ ` . , , , , ,. 3 ,. �� `� °� ' C�RTIFICATE OF LIABILITY INSURANCE � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFPIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI2ED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A sWtement on this certificate does not confer rights to the certiflcate holder in lieu of such endorsement(s�. PRODUCER Lockton Companies, LLC-1 Kansas City NAME: 444 W 47th Street, Suite 900 ac No eXc : ac No : Kansas City MO 64112-1906 E-MAIL (816) 960-9000 AD Re : IN RER AFFORDIN C VERA E IC p INSURER A. Travelers Property CasualTy Co of Amenca 25674 INSURED B�.p�CK BOX NETWORK SERVICES - FLORIDA INSURER B. St Paul Fve and Manne Insurance Company 24767 1007290 3247 TECH DRIVE NORTH INSURER C. ST PETERSBURG FL 33716 INSURER D . IN RER E . IN R RF: COVERAGES BLABO01 CE CERTIFICATE NUMBER: 11199954 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �L7R TYPE OF INSURANCE �gp S y�yyp POLICY NUMBER POLICY EFF POLICY EXP LIMITS MMIDDMlYY MNVDD A GENERAL LIABILITY �( N HC2J 3/31/2011 3/31/2012 EACH OCCURRENCE 1 OOO OOO X COMMERCIAL GENERAL LIABILITY PREMISES� a occurr 1 OOO OOO CLAIMS-MADE� OCCUR MEDEXP An one ereon 1� �Q� X$1 O MILLION TOTAL PERSONAL & ADV INJURY $ 1 OOO OOO AGGREGATE GENERAL AGGREGATE $ Z� OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2 OOO OOO PRO- P LI Y X JECT LOC S p AUTOMOBILE LIABILITY N N TC2J 3/31/201 ] 3/31/2012 EO aB aeD INGLE LIMIT $ 2 00 � QQ � X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX AUTOS NED qUTOS BODILY INJURY (Per acadent $ XXXXXXX X HIRED AUTOS X qON Pe�a�d $ XXXXXXX $ XXXXXXX B X UMBRELLA LIAB X OCCUR N N QKO 8001 147 3/31/2011 3/31/2012 EACH OCCURRENCE $ IO OOO OOO EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1 O OOO OOO DED X RETENTION $O $ XXXXXXX A WORKERS COMPENSATION WC gTATU- OTH- ANDEMPLOYERS'LIABILITY N TC2N (AOS) 3/31/2011 3/31/2012 X TORYLIMITS A Y/N TRJ-UB-131J2235-11 3/31/2011 3/31/2012 A OFFICER/MEM ER EXCLUD D XECU7NE � ry� p �AZ, MA, OR, WI� E L. EACH ACCIDENT $ 1 OOO OOO (MandatoryinNH) E.L DISEASE-EAEMPLOYEE 1 OOO OOO Ifyes, describe untler DESCRIP710N OF OPERATIONS below E L. DISEASE - POLICV LIMIT 1 OOO OOO DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I(Attach ACORD 101, Additlonal Remarks Schedule, ff more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 117 99954 AUTHORIZED REPRESENTATIVE CITY OF ZEPHYRHILLS BUILDING DEPT 5335 8TH ST ZEPHYRHILLS, FL 33542 ACORD 25 (2010/OS) O 9 8-2010 AC ORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD � � ;:> s�ACK sox� -- �_� � � , - �":� � ,` GOVERNMENT SOLUTIONS Business Address Black Box Network Services-Government Solutions 3247 Tech Dr N St. Petersburg, FL 33716 (o) 727-571-4144 (� 727-573-5789 License Holder Todd Joseph Chouinard ES0000369 (c) 727-638-7605 3247 Tech Dr North, St. Petersburg, FL 33716 Phone: 727.571.4144 Fax: 727.573.5789 State Lic: E50000369 Page is too large to OCR. Page is too large to OCR.