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18-19908
Zephyrhills
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18-19908
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Last modified
5/23/2019 9:54:52 AM
Creation date
5/23/2019 9:54:51 AM
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Building Department
Company Name
ZEPHYRHILLS MERCHANT SQUARE LLC
Building Department - Doc Type
Permit
Permit #
18-19908
Building Department - Name
ZEPHYRHILLS MERCHANT SQUARE LLC
Address
7403 GALL BLVD
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^ <br /> The following attachments are provided es required: <br /> 1. Qualification statements and/or eaumoo of the private provider and all duly authorized <br /> representatives <br /> 2. Proof ofinsurance for professional and comprehensive liability in the amount of $1 million per <br /> uununenup and $2 million in aggregate for any project with a construction cost of $5 million or <br /> less and $2 million per occurrence and $4 million is aggregate for any project with a construction <br /> cost of over$5million. <br /> Individual Corporation ' Partnership <br /> Print Corporation N Print Partnership Name <br /> By: By-. <br /> (signature) _J6ignatbre) (signature) <br /> Print Print Print <br /> Wenne: Name: Robert Ford Name: <br /> Its: Its: <br /> Address: Address:Ad@nsss Address-, <br /> Po Box 4411wm.Kennesaw,mu 301e0 <br /> Telephone Telephone 480'378'1538 Telephone <br /> No.: No.. No.. <br /> Please use appropriate notary block, <br /> STATE OF <br /> COUNTY OF <br /> ind6/idws| Corporation Partnership <br /> � <br /> Before me,this ________day of Before me, this Before me,this _______ day of <br /> 20__. personally ,2O__.personally <br /> appeared appeared <br /> of Partner/agent <br /> ACmqooratioo, <br /> on behalf of the state corporation Apartnorship, <br /> who executed the foregoing who oxouuk»d the foregoing who executed the foregoing <br /> inotnummnt, and acknowledged inohnmant, and acknowledged instmment, and acknowledged <br /> before me that same was before me that name was before ma that same was <br /> executed for the purposes executed for the purposes executed for the purposes <br /> therein expressed. therein expressed, therein expressed. <br /> Personally known v/ or produced identification Type nf identification produced <br /> Signature ofNotary Print Name Notary Public:PubUc NOTARY STAMP BELOW <br /> &1y commission expires: <br /> Page 2cd2 <br />
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