HomeMy WebLinkAboutPPP Compliance Affidavit0UN1V,'____`,RSAL
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ENGINEERING SCIENCES
DR Horton-Creekside
California 1VModel7Lot.27
3428.Trinity Circle
Fort: Pierce, FL
Private Provider .
Plan Compliance Affidavit
-California Model-3428.Trinity Circle
Private Provider Firm: " :.Universal Engineering Sciences
Private Provider: John Carl Peterson
:♦ Al T'_____ 7-1 J-11 AA0,C.
reviewed . for. _ and are: in . compliance With 'the Florida -Building :Code and :all _ local
amendments to .. the . Florida Building .Code • by the 'following'' affiant, who i,s . ' duly
authorized to perform plans review' pursuant: to Section. 553.791, Florida Statute. and
holds the appropriate license: or certificate:
Name: John Carl Peterson Revised Plan Sheets:::C-1, GN,.A1, A2-C; El-I'L •M1-,.Dl., D2,
WAL WA2; WA3, WA6; S1, SLIA: 51.2, S1.2A,.'S2,1S2.lA, S22A,.S3; S11A, S11B�
S3.1C, SN1:.
Florida License/Registration/Certification #(s) and description:
John Carl Peterson:.
RPX 243
Signature of Reviewer: 7, aem. f.
John Carl PetersonBU i 721 , .
SWORN AND SUBSCRIBED. b fore me by "
being personally known to me or Navin roduced as. identification
- gp .
and who being fully sworn_ and, cautioned, state
that the foregoing is true d. correct to the best of. his/her.knowledge or belief..
Signature of Print Name
Not, Publi : NO ARY STAMP BELOW
My commission expires:
A �.v':� • _ SRITTANVLYNN JOZAMS
(+P, Notary Public � State of Florida
Commission d NI+ 106455
/or n�'� My Comm, Expires Mar 21.2025
Bootee :rre�gn vaticnal wctary Assn.