HomeMy WebLinkAboutPrivate Provider Plans Compliance AffidavitLOCATIONS
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Private Provider Plans :Compliance Affidavit
Private -Provider Firm: G'FIA International
Private Provider: Ric.h.ar.d J06rson..
Address:.' 607 NW Commodity Cove
u Port St L'cie, FL 34986'
Phone: (772)924._ 357.5.
Fak: (772)924-3580
fmail: Sdheduling@tearrgfaxqrn
Pi9ject. Name -
Sheets: -..G.g.p2 0'2j LP2 .1.0. GRP2 1.2, (TRP! 2 1 GRP-2 -3.3 -GRP2.4t M 0,GRPI 4.1 GR-P2 5.1
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.1 :hereby certify that to the.bett of my knowledge, information; . , and belief he .reference plans
submitted. were reviewed for,. an . d are . in bohipli . ande with; the mFlorida Building Co . de and all local
amendments to the:2017 Floricla.Buildifij Code. by'thefol.low''ing: offi-drit, who i,smduly authorized to
06r(orfn_plans review pursuant to Section 553.791, Florida Statute of holdsthe appropriate license
or c6rtific6te'.'
:Jbhn.Carl. Peterson.
.R-PX.243'
.Plans Examiner
Richard- Jefferson
PX 51 I.-EIN 1-164.. 130 1 368 Signature: j Date:
14— T
Private Provider
State of'F iorida
.COUNTY of. Palm Beadh.
SWORN AND SUBSCRIBED before me . on the. J(Q
day of 1\[()VCWj0e4- 20 2Z)
,by Richard Jdffersohj being personally kn6wn.to Me andwho. being. fully sw6m.'and dautioried,
.6tate'that the 4progoing is.trueand correct to the best of his/her knowledge of belief.
Signature of -Notary
Notary Public Expires: [j
PrintName:
Notary Stamp: