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Alternative Service Agreement
Prolect:'OR Horton-Grekside = 9617 Potomac- Drive.' -Fort Pierce, FL 34945mLot 19. -
Private Provider Firm: Universal Engineering Sciences-.._
Private'Provider Name:' John -Carl Peterson
Address: 607 -Commodity Cove, Port St:. Lucie, 34986
Phone: (772).,924-3575 Fax: .(772),924-3580-.-
Nam6s, License/Certificate' "Numbers, and Lic'ense.dekriptio'n of provider and:duly
y authorized :agents Who will be
providing §ervices,fbe this project.
Name':..
'L.11c6ns6/.Cert11ficat6 No.", : :
License/Ceirtificate.-Type".'
..Mbitthew Chaney
B_N#7342
•
'Inspebtor-' Building..-
..D6n D6t&rman'.,..
`BN# 4688'
Irispe6tor.::-�Buildin'g..(l-'and 219mily),- Plumb ing:.
.Jose.a.n Duprey ..'
B.N#:7330
'Inspe6for-'Bbilding..'
Carl Peterson'.
BN# 5555 RPX# 243
lnspe6tor,_7'MEP,, Building.
Michael Benton
W-8067.
Inspector- ln9pe6t6rmBuilding.(1.a'nd -2 family),'
Mechanical, Plumbing.
Donald Green
N#7301-.
'lnsppdt6rmElectrical
'Vincent Burdo.
BN#5337
Insp jector-8ectrical,:'PlUmbing Mechanical-
17 - 7.
As the Private inspection services provider for this project, I have read and agree to be bound to the provisions..of State
Statute'553.791A furthdragre6 and understand that only the above listed 'personnel may: Oerforrn inspections on this
project and-that if for any reason the inspection ersonnel should change; r- if any person listed above -shoul.d:'discohtin,ue--- -
P ge o.
to quality as a.duly authorized agent,. you will be notifi in writ' g imm i ely.
Representative Name:
Signature.
-State of Florida, County. of Palm Beach,.
Sworn to (or affirmed) a nd subscribed b . efore me this�day-of 2021, b Peen
who is personally known to me.
j0241+ts
Pfi . nted: name, of. Nothry:, ftfiatu . re of. Notary
Notary Public.Stamp
BRITTANY LYSIN JOZA ITIS
Notary Public - State of Florida
My, Comm, EXPIros Mdf