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Geotechnical Engineering I Construction Materials Testing and Inspections
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Alternative Service Agreement
Project: 7008 Plumosa Lane
Private Provider Firm: GFA International
Private Provider Name: Richard Jefferson
Address: 607 Commodity Cove, Port St. Lucie, FL 34986
Phone: (772) 924-3575 Fax: (772) 924-3580
Names, License/Certificate Numbers, and License description of provider and duly authorized agents who will be providing
services for this project.
Name:
License/Certificate No.:
License/Certificate Type:
Matthew Chaney
BN# 7342
Inspector — Building
Don Determan
BN# 4688
Inspector — Building (1 and 2 family), Plumbing
Josean Duprey
BN# 7330 PX# 4208
Plan Review — Building, Inspector - Building
Juan Hernandez
BN# 5582 PX# 2646
Plan Review —Mechanical, Inspector —
Mechanical
Richard Jefferson
BN# 1164 PX#513
Plan Review — All Trades, Inspector — All Trades
George Johnson
BN# 6541 PX# 3541
Plan Review— Plumbing, Inspector -Plumbing
William McColman
BN# 7752
Inspector - Building
Carl Peterson
BN# 5555 PX# 2764
Plan Review— Residential, Inspector— MEP,
Building
As the private inspection services provider for this project, I have read and agree to be bound to the provisions of State
Statute 553.791. 1 further agree and understand that only the above listed personnel may perform inspections on this
project and that if for any reason the inspection personnel should change, or if any person listed above should discontinue
to quality as a duly authorized agent, you will be notified in writing immediately.
Representative Name:
State of Florida, County of Palm Beach,
Sworn to (or affirmed) and subscribed before me this _LLday of IN �U� ��'r , 2020, by
who is personally known to me. IIIIII1110
Slna,�vwh �Gl�or I
Printed name of Notary
Notary Public Stamp:
Signature of Notary