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Private Provider Plans Compliance Affidavit
Private Provider Firm: Universal Engineering Sciences
Private Provider:
Richard Hoaglin 820
Address:
Brevard Ave,
Rockledge, FL 32955
Phone:
321-638-0808
Fax:
321-638-0978
Email:
RHoaglin@universalengineering.com
Project Name: DR Horton, Creekside Plat 4, Lot 39
Sheets: -C1_, CAN, Al. A2C.El, P1, ML D1, D2, WAl, WA2, WA2, WA6„ S1 1 lA, S1.2. S1,2A, 2, S2.1A,
S3, SMA, S3.1B, S3.1C, SNl, PAl
hereby certify that to the best of my knowledge, information, and belief he reference plans
submitted were reviewed for, and are in compliance with, the Florida Building Code and all local
amendments to the 2017 Florida Building Code by the following affiant, who is duly authorized to
perform plans review pursuant to Section 553.791, Florida Statute of holds the appropriate license
nr nprtifirntP_
Richard Olds
PX 2178 S
Plans Examiner
Richard Hoaglin
PE 48796 S
Private Provider
-1, W FF *4
AM "
State of Florida
COUNTY of
SWORN AND SUBSCRIBED before me on the ` day of , 20�
b'CLIQ,tXt'il being personally known to me and who bein fully sworn and cautioned,
state that the forego) g is true nd correct to the best of his/her knowledge of belief.
r,iJrr�
S' ature of Obtary V Print Name:
Notary Public Expires: Notary Stamp:
tism;1-1
JenndferJeeme FullerNotary Public
State of Florida
Comm# HH035937
river Expires 8/24/2024