HomeMy WebLinkAboutPrivate Provider Plans Compliance AffidavitLOCATIONS_
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Private Provider Plans :Com-pliance.Af .idavit
Private Provider Firm:
GFA International
Private Provlder:
Richard Jefferson .
Addhess:.
607 'NW Commodity Cove
Port St: Lucie, FL 34986
Phone:
(772)924=3575
Fax:
(772)924-3580.
Email:
Scheduling@teamgfa:com
Project Name:
Sheets:
. GRP2 0.2: GRP2-0.4: GRP2 1'.0. GRP2 1:2. GRP2 2:3: GRR2 3.3 GRP2 ;4:O..GRP2' 4.3: GRP2 5.1
GRP2 6'.2; 0:0 1.0 ,,, 1.1 2.0, _ 1.0,SD1.0,
I hereby certify that to the, of niy 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.affiarit, Who is :duly authorized to
perfor n.plans review"pursuant to Section 553.791, Florida Statute of holds.the. appropriate license
or certificate:
John .Carl. Peterson
RPX 243
Plans Examine
Richard Jefferson
PX.511 BN 1164:.BO 1368 Signature: 0 19 Date:
Private Provider
State of Florida
COUNTY'of'Palm Beach
SWORN AND SUBSCRIBED before me on the - . � day of I bU�-bYl ►u P 920 7�
by Richard 'Jefferson; being personally known to me'and.who being fully sworn and cautioried,
state that:th6 foregoing is. true and coreeet to the best of his/her knowledge of belief:
NotarySignature of /
Notary•Public Expires: • Q.� I.l'I (Z3
Print Name:
,,Yllt,llllll,,,NotaryStamp: �D��'�•
.•`*� 86914118 :41
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